Trauma and Glaucoma Emergencies

• A tear in the anterior face of the ciliary body, with damage to the major arterial circle of the iris, arterial branches to the ciliary body, or veins coursing between the ciliary body and episcleral venous plexus • In most cases, the hyphema clears in a few days, with the red blood cells exiting the eye through the trabecular meshwork • The size of initial hyphema has prognostic significance regarding final visual acuity. • 76% of subtotal hyphemas attain a visual acuity of 20/50 or better, whereas only 35% of total hyphemas attain a visual acuity of 20/50 or better. •Overall in literature: 3.5% to 38% • Scandinavian literature: 2% to 9% • Most studies in urban North American centers: 20% to 30% •Clot lysis and retraction from the traumatized vessel can lead to a rebleed. • Usually between the third and the fifth day Increase in the size of the hyphema, a layer of fresh blood over older blood, and dispersed erythrocytes over the clot once the blood has settled •Ocular hypotony, hypertension, use of aspirin, and African-American race • The incidence of rebleed does not seem to correlate with the size of hyphema. Therefore, the use of medications to prevent rebleed should not depend on the size of hyphema. • Approximately one third of all patients with hyphema have increased IOP. • Obstruction of the trabecular meshwork by erythrocytes and blood products or damage to the trabecular meshwork function • In larger hyphemas, pupillary block by a blood clot can also contribute to increase in IOP. • Peripheral anterior synechiae (PAS) •Persistence of hyphema for more than 1 week can result in the formation of PAS. •Approximately 6% of patients have optic atrophy, exhibited by optic nerve pallor. • Secondary to elevated IOP or optic nerve contusion •The risk of optic atrophy appears to be greater if the IOP is allowed to remain 50 mmHg or more for 5 days or 35 mmHg or more for 7 days in sickle cell-negative patients without prior optic nerve damage. •The incidence of corneal blood staining is between 2% and 11% and is much higher in patients with a total hyphema.