History |
Typically caused by blunt trauma to the orbit |
Associated injuries: head trauma, orbital fracture, posterior segment injury (vitreous, retina, choroid, and/or optic nerve), and open globe (rare) |
Risk factors for poor outcome: sickle cell disease or trait, bleeding tendency (eg, hemophilia, von Willebrand disease, or anticoagulated) |
Causes of spontaneous hyphema (rare): diabetes mellitus, clotting disorder, eye tumor, or (in children) child abuse |
Clinical features |
Signs of open globe: Emergency ophthalmology consultation indicated if present!* |
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Clinical findings of hyphema: All patients with hyphema warrant prompt evaluation by an ophthalmologist. |
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Diagnostic evaluation |
Comprehensive eye examination by an ophthalmologist |
Solubility testing (eg, Sickledex) or hemoglobin electrophoresis in susceptible patients (eg, African or Mediterranean descent or positive family history) with uncertain sickle hemoglobin status |
CBC, PT, PTT, INR for patients with bleeding dyscrasia; perform other blood and urine studies based on presence and degree of other injuries |
Orbital CT without contrast with 1- to 2-mm axial and coronal cuts through the orbits if any one of the following: |
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Initial treatment |
Assess and treat life-threatening injuries |
If rapid sequence intubation necessary: |
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If bleeding tendency: Treat any underlying bleeding dyscrasia. For anticoagulated patients, consult with a specialist. |
Place an eye shield without placing pressure on the affected eye and maintain except during eye examination. |
Elevate the patient's head to 30 degrees and maintain the patient at bed rest. |
Cycloplegia: Dilate pupil for examination; also provides pain relief. Caution! Do not dilate if an open globe is suspected; consult an ophthalmologist. |
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Control nausea and vomiting: Administer ondansetron (in adults, 4 mg; in children, 0.15 mg/kg, maximum single dose: 4 mg) IV or orally.¶ |
Pain: Topical pain control. Caution! Do not instill if an open globe is suspected; consult an ophthalmologist. |
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Additional pain control: If topical pain control is insufficient, give |
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Ensure definitive management by an ophthalmologist |
IOP: intraocular pressure; CBC: complete blood count; PT: prothrombin time; PTT: partial thromboplastin time; INR: international normalized ratio; CT: computed tomography; IV: intravenous; SQ: subcutaneous; NSAIDs: nonsteroidal antiinflammatory drugs (eg, ibuprofen, ketorolac); ECG: electrocardiogram.
* Refer to UpToDate topics on open globe injuries.
¶ Ondansetron should be avoided in patients with congenital long QT syndrome. ECG monitoring should be performed for patients receiving ondansetron who also have the following conditions: electrolyte abnormalities (eg, hypokalemia, hypomagnesemia), congestive heart failure, or bradyarrhythmias; or are taking medications that prolong the QT interval.Do you want to add Medilib to your home screen?