Adolescent Male With Eye Pain

Article Outline

• Diagnosis
  • Hyphema and iridodialysis (Figure)
• Reference
• Copyright

[Ann Emerg Med. 2008;52:572.]

A 13-year-old male was brought to the emergency department with complaint of eye pain. He experienced blunt trauma when the cap of a soda bottle exploded into his eye after he mixed baking soda and vinegar in the container. On examination, the patient had the findings described (Figure).

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• Figure. 

  Eye findings following blunt trauma. Used with permission of Christopher P. Holstege, MD, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia, Charlottesville, VA.

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Diagnosis 

Hyphema and iridodialysis (Figure) 

The annual incidence of hyphemas is 17 per 100,000 population.¹ Hyphemas most commonly result from blunt trauma but also occur spontaneously from systemic disorders such as sickle cell disease. Approximately one third of all cases exhibit associated increased intraocular pressure. A complication of traumatic hyphemas is secondary bleeding, which occurs in 3% to 38% of patients.¹ In general, visual prognosis and complications are significantly worse in the setting of total hyphema as opposed to subtotal hyphema and in cases in which rebleeding occurs.

Outpatient management of hyphemas has become more accepted if the hyphema occupies less than half of the anterior chamber, intraocular pressure is less than 35 mm Hg, and there is no history of blood dyscrasia or bleeding diathesis.¹ A mydriatic (ie, atropine 1%) is administered to relieve photophobia and to prevent seclusio pupillae. A topical corticosteroid (ie, prednisolone acetate 1%) is administered to reduce the risk of synechiae and secondary hemorrhage. Activity should be limited, the head of the bed elevated 30 degrees above the horizontal plane, and a metal shield placed over the eye. Aspirin and nonsteroidal anti-inflammatory drugs should be avoided. (Figure).

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Reference 

1. Sankar PS, Chen TC, Grosskreutz CL. Traumatic hyphema. Int Ophthalmol Clin. 2002;42:57–68
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