Is Hyphema a Contraindication for Measuring Intraocular Pressure?
No, hyphema is not a contraindication for measuring intraocular pressure—in fact, IOP measurement is essential in hyphema management because elevated IOP is one of the most common and sight-threatening complications requiring immediate treatment. 1, 2
Why IOP Measurement is Critical in Hyphema
Elevated IOP occurs frequently with hyphema and represents one of the major complications that can lead to glaucomatous optic atrophy and permanent vision loss. 1, 2
IOP monitoring guides treatment decisions, including whether to initiate or escalate antiglaucoma medications and when surgical intervention becomes necessary. 2, 3
Secondary hemorrhage (rebleeding) occurs in up to 38% of cases, typically 3-5 days post-injury, and can cause dangerous IOP spikes requiring close monitoring. 1, 2
Contrast with True Contraindications
The absolute contraindication for IOP measurement is penetrating eye injury (open globe), not hyphema. 4, 5
In penetrating injuries, any pressure applied to the globe can cause extrusion of intraocular contents through the wound, potentially causing irreversible vision loss. 5
Hyphema from blunt (closed globe) trauma does not carry this risk, as the globe remains intact. 2, 6
Optimal Tonometry Technique in Hyphema
Goldmann applanation tonometry remains the standard method for measuring IOP in hyphema patients, as the cornea is typically intact and the measurement technique does not worsen the hyphema. 4, 2
If corneal edema impairs visualization during examination, topical glycerin can temporarily clear the cornea, but this does not preclude IOP measurement. 4
Alternative tonometry methods should be considered if corneal abnormalities exist (edema, irregularity, scarring), including pneumotonometer, dynamic contour tonometer, or ocular response analyzer. 7, 4
Clinical Management Implications
IOP-reducing medications are frequently required in hyphema management when significant IOP elevation occurs. 1, 2
Medical therapy should be tailored to each case but commonly includes topical antiglaucoma agents alongside cycloplegics, corticosteroids, and potentially antifibrinolytic agents. 1, 2
Surgical intervention becomes necessary when IOP remains dangerously elevated despite maximum tolerated medical therapy or when corneal blood staining develops. 2
Patients with sickle cell trait or disease require particularly aggressive IOP monitoring, as these eyes tolerate even minimal IOP elevations poorly; lack of IOP control within the first 24 hours predicts continued difficulty and may necessitate earlier surgical intervention. 8
Key Clinical Pitfall
The critical error is failing to measure IOP in hyphema patients due to misunderstanding the contraindication, which applies only to open globe injuries. 5, 2 Regular IOP monitoring is mandatory throughout the treatment course, with particular vigilance during the 3-5 day window when rebleeding risk peaks. 1, 2