Q J Med 2015; 108:593

doi:10.1093/qjmed/hcu244 Advance Access Publication 18 December 2014

Clinical picture

Secondary hemorrhage in traumatic hyphema

A 40-year-old man presented with 3 h history of the blood. Topical atropine (in order to reduce iris
acute painful vision loss of his right eye. He reported movement) and steroids (inhibiting fibrinolysis) were

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a blunt trauma of the same eye 7 days prior to ad-
mission. At examination his visual acuity was
reduced to light perception. Slit lamp examination
revealed a multilayered hyphema (collection of
blood in the anterior chamber). A layer of fresh
blood (empty arrows) was noted over the darker
clot (white arrows) in the anterior chamber
(Figure 1). The intraocular pressure (IOP) was
increased (40 mmgh).
Hyphema is usually caused by blunt or penetrating
ocular trauma. Spontaneous hyphema may occur as
well (iris neovascularization, intraocular tumors . . .).
Rebleeding after traumatic hyphema occurs clas-
sically in the first week after the first hemorrhage.
Besides the importance of hyphema, rebleeding is
one of the main prognostic factors which are gener-
ally associated with a poor functional result.
It must be suspected if the size of the hyphema
increases or if a supernatant of red clear blood is
noted over the older clot in the anterior chamber.1
Untreated it may lead to complications2 such as
increased IOP, corneal bloodstaining (hematocornea)
and optic atrophy. So it is reasonable to consider the
predisposing factors in the management of this con-
dition like: Clotting and blood disorders (hemophilia,
sickle cell anemia), uncontrolled hypertension or
induced hypertension (physical effort), marked
ocular hypotony, clot dissolution.
Thus our patient was placed at bed rest with head
end elevation in order to facilitate inferior settling of
given with IOP lowering therapy.
A work up was performed including: complete
blood cell count, activated partial thromboplastin
time, prothrombin time, all of which were
unrevealing.
The ocular echography excluded other associated
ocular lesions (traumatic cataract, retinal detach-
ment, vitreous hemorrhage).
The uncontrolled IOP (within 48 h) required a sur-
gical evacuation with a favorable postoperative
evolution. The patient regained progressively a
visual acuity of 10/10 within 2 weeks.
Photographs and text from: Z. Hafidi, Y. Amrani, S.
Berradi, H. Handor and R. Daoudi, Faculty of
Medicine, Department A of Ophthalmology,
Teaching Hospital of Rabat, University of
Mohammed V, Rabat, Morocco. email:
zouheirhafidi@gmail.com
Conflict of interest: None declared.
References
1. Walton W, Von Hagen S, Grigorian R, Zarbin M.
Management of traumatic hyphema. Surv Ophthalmol
2002; 47:297–334.
2. Lai JC, Fekrat S, Barron Y, Goldberg MF. Traumatic hyphema
in children: risk factors for complications. Arch Ophthalmol.
2001; 119:64–70.

Figure 1. Slit lamp examination of the right eye showing a multilayered hemorrhage of the anterior chamber (hyphema),
with a dark clot (white arrow) overhung by a layer of fresh blood (empty arrows).

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