Blood In The Eye: Managing Hyphema7:00 AM
Thursday our office got a phone call for an emergency work-in appointment. A 13 year old boy got hit in the eye playing flag football at school, and now 2 hours later his vision was getting blurry. A history like this definitely warranted him being seen as soon as possible, so thirty minutes later he was in my chair. My technician gave me a quick over view before I went into the room, but I heard only one sentence before my mind immediately grasped out situation. "And I can see blood in his eye!" A red eye is one thing, but when you see blood actually trapped inside the front of the eye, we're onto something much more serious.
|I wish I had taken a picture of my patient, but the presentation was almost identical to this photo via|
|We typically see hyphema in the office due to injuries during sports, but they can also occur spontaneously in patients using strong blood thinners or with hemolytic conditions. The patient above had hyphema secondary to warfarin use. via|
In addition to paralyzing iris constriction and dilation with a cycloplegic drop, the patient needs to decrease their own movement as much as possible too. Bed rest with the head elevated until the blood has fully reabsorbed is the general rule of thumb. At 13 years old, our patient was told to stay home from school (we supplied a note) and he was to stay in bed and rest as much as possible, getting up when necessary to only to eat, use the bathroom, and come to our office for follow-ups. In cases of smaller hyphemas, the patient is typically monitored every 48 hours until the blood has reabsorbed to ensure improvement without rebleeds.