TRAUMATIC HYPHEMA

It is the accumulation of blood in the anterior chamber of eye following trauma. Trauma is the most common cause of hyphaema. Traumatic hyphaema may occur following both blunt and penetrating injuries. A ruptured iris blood vessel generally causes bleeding. Hyphaema may affect vision by blocking the visual axis. Hyphaema may also be a sign of associated damage to intraocular tissues. Damage to intraocular tissues may be the cause of poor vision in spite of resolution of hyphaema.

The anterior chamber is the area bounded by the cornea anteriorly, the angle laterally, and the lens and iris posteriorly. This space normally contains clear, aqueous humor, which is produced by the ciliary body and drained through the Canal of Schlemm.  A hyphema is usually painful. If left untreated, it can cause permanent vision problems.

CAUSES:

Traumatic hyphaema predominantly affect males in the age group below twenty years

Following conditions may produce spontaneous Hyphaema

• Rubeosis iridis
• Retinoblastoma
• Juvenile Xanthogranuloma
• Haemophilia
• Leukaemia
• Anticoagulant therapy
• Iatrogenic hyphaema may occur during intra-operative procedures or may develop post-operatively. Hyphaema may also develop following ocular laser procedure.
• Spontaneous hyphaema may be secondary to neo-vascularisation, ocular neoplasms, uveitis or vascular anomalies.

SYMPTOMS 

• Pain in the eye.
• Diminution of vision
• Photophobia
• Drowsiness, especially in children

DIAGNOSIS:

• comprehensive eye exam to test your ability to see
• eye pressure check
• examination of inside of the eye with a special microscope called a slit lamp
• a CT scan might be ordered to check for fracture of the orbit (socket) if there was trauma to the eye

The grades are:

• Microscopic:Circulation of red blood cells only, no layering.
• Grade I:Less than 33% of anterior chamber is filled with blood.
• Grade II:33%- 50% of anterior chamber is filled with blood.
• Grade III:50%- 95% of anterior chamber is filled with blood.
• Grade IV:100% of anterior chamber is filled with blood (Total or ‘Eight ball’ hyphaema).

COMPLICATIONS 

• Increased intraocular pressure
• Corneal blood staining
• Formation of peripheral anterior synechia
• Secondary haemorrhage
• Optic atrophy

HOMOEOPATHIC MANAGEMENT:

BOTHROPS - blindness from hemorrhage into retina. Hemoralopia, day blindness, can hardly see her way after sunrise, conjunctivial hemorrhage.

PHOSPHORUS- Thrombosis of retinal vessels and degenerative changes in retinal cells. Blood extravasations;

ARNICA- retinal hemorrhage. Bruised, sore feeling in eyes after close work. Must keep eyes open. Dizzy on closing them. Feel tired and weary after sight-seeing

HAMAMELIS- Painful weakness, sore pain in eyes, bloodshot appearance, inflamed vessels greatly injected. Hastens absorption of intraocular hemorrhage.

LACHESIS- Defective vision after diphtheria, extrinsic muscles too weak to maintain focus. Sensation as if eyes were drawn together by cords which were tied in a knot at root of nose.