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bleeding into the interior chamber of the eye

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/07/20 15:28:47」(JST)

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The eye is divided into a small front (anterior) segment, in front of the lens, and a large rear (posterior) segment, behind the lens. The anterior chamber is the light gray area at the top of this illustration.

Hyphema (or hyphaema, see spelling differences) is blood in the front (anterior) chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea.

Epidemiology[edit]

The rates of hyphemas in the United States are about 20 cases per 100,000 people annually.^[1]

Causes[edit]

Hyphemas are frequently caused by injury, and may partially or completely block vision. The most common causes of hyphema are intraocular surgery, blunt trauma, and lacerating trauma. Hyphemas may also occur spontaneously, without any inciting trauma. Spontaneous hyphemas are usually caused by the abnormal growth of blood vessels (neovascularization), tumors of the eye (retinoblastoma or iris melanoma), uveitis, or vascular anomalies (juvenile xanthogranuloma).^[1] Additional causes of spontaneous hyphema include: rubeosis iridis, myotonic dystrophy, leukemia, hemophilia, and von Willebrand disease.^[2] Conditions or medications that cause thinning of the blood, such as aspirin, warfarin, or drinking alcohol may also cause hyphema.

Prognosis[edit]

Hyphemas require urgent assessment by an ophthalmologist as they may result in permanent visual impairment.

A long-standing hyphema may result in hemosiderosis and heterochromia. Blood accumulation may also cause an elevation of the intraocular pressure. On average, the increased pressure in the eye remains for six days before dropping.^[1] Most uncomplicated hyphemas resolve within 5–6 days.^[1]

Treatment[edit]

The main goals of treatment are to decrease the risk of rebleeding within the eye, corneal blood staining, and atrophy of the optic nerve. Small hyphemas can usually be treated on an outpatient basis. Most treatment plans consist of elevating the head at night, wearing a patch and shield, and controlling any increase in intraocular pressure. Surgery may be necessary for non-resolving hyphemas, or hyphaemas that are associated with high pressure that does not respond to medication. Surgery can be effective for cleaning out the anterior chamber and preventing corneal blood staining.^[2]

Elevation of the head of the bed by approximately 45 degrees (so that the hyphema can settle out inferiorly and avoid obstruction of vision, as well as to facilitate resolution). Bed rest may be considered, although evidence suggests that it does not improve outcomes. Wearing of an eye shield at night time (to prevent accidental rubbing of the eyes during sleep, which can precipitate a rebleed). An eye patch should be worn throughout the day to protect the injured eye.

If pain management is necessary, acetaminophen can be used. Aspirin and ibuprofen should be avoided, because they thin the blood and increase the risk of a rebleed.^[3] Sedation is not usually necessary for patients with hyphema. It is controversial among ophthalmologists whether a steroid medication or a dilating drop (mydriatic) should be used in treatment of hyphema. Steroids aim to reduce the amount of inflammation, but also cause side effects. Dilating drops aim to increase comfort from the traumatized iris as well as reduce bleeding, but can also cause the pupil to be fixed in a dilated state via posterior synechiae (adhesions).

Complications[edit]

While the vast majority of hyphemas resolve on their own without issue, sometimes complications occur. Traumatic hyphema may lead to increased intraocular pressure, peripheral anterior synechiae, atrophy of the optic nerve, staining of the cornea with blood, re-bleeding, and impaired accommodation.^[2]

Secondary hemorrhage, or rebleeding of the hyphema, is thought to worsen outcomes in terms of visual function.

References[edit]

^ ^a ^b ^c ^d Sheppard, John D. "Hyphema". WebMD, LLC. Medscape. Retrieved 29 November 2012.
^ ^a ^b ^c Walton, William; Von Hagen, Stanley; Grigorian, Ruben; Zarbin, Marco (July–August 2002). "Management of Traumatic Hyphema". Survey of Ophthalmology 47 (4): 297–334. doi:10.1016/S0039-6257(02)00317-X. PMID 12161209. Retrieved 29 November 2012.
^ Crawford, JS; Lewandowski, RL; Chan, W (September 1975). "The effect of aspirin on rebleeding in traumatic hyphema.". American journal of ophthalmology 80 (3 Pt 2): 543–5. PMID 1163602. Retrieved 29 November 2012.

External links[edit]

Hyphema - Handbook of Ocular Disease Management

UpToDate Contents

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1. 外傷性前房出血：マネージメント traumatic hyphema management
2. 外傷性前房出血：臨床的特徴および診断 traumatic hyphema clinical features and diagnosis
3. Overview of eye injuries in the emergency department
4. 視覚変化が認められた小児患者に対するアプローチ approach to the pediatric patient with vision change
5. Approach to eye injuries in the emergency department

English Journal

Controversies in ocular trauma classification and management: review.

Agrawal R, Shah M, Mireskandari K, Yong GK.SourceDepartment of Ophthalmology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, rupesh_agrawal@ttsh.com.sg.
International ophthalmology.Int Ophthalmol.2013 Aug;33(4):435-45. doi: 10.1007/s10792-012-9698-y. Epub 2013 Jan 22.
Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outc
PMID 23338232

Enhanced trabeculectomy in a UK district general hospital setting: is selective use of 5-fluorouracil all that is required?

de Klerk TA, Chaudhry N, Moriarty AP.SourceStepping Hill Hospital, Stockport, UK, timothydeklerk@yahoo.com.
International ophthalmology.Int Ophthalmol.2013 Aug;33(4):447-51. doi: 10.1007/s10792-012-9712-4. Epub 2013 Jan 20.
To determine whether primary trabeculectomies performed in a UK district general hospital, specifically without making use of mitomycin-C augmentation but with selective use of the low potency anti-metabolite 5-fluorouracil, produce an acceptable long-term intraocular pressure (IOP)-lowering effect
PMID 23334661

NAIL GUN-INDUCED OPEN-GLOBE INJURIES: A 10-Year Retrospective Review.

Kolomeyer AM, Shah A, Bauza AM, Langer PD, Zarbin MA, Bhagat N.SourceInstitute of Ophthalmology and Visual Science, New Jersey Medical School, Newark, New Jersey.
Retina (Philadelphia, Pa.).Retina.2013 Jul 11. [Epub ahead of print]
PURPOSE:: To describe the characteristics of nail gun-related open-globe injuries.METHODS:: Retrospective series of all patients presenting with open globes secondary to nail gun injury from 2000 to 2010. Data were collected on demographics, setting of accident, presenting clinical examination findi
PMID 23851631

Japanese Journal

Twenty five-gauge sutureless vitrectomy versus 20-gauge vitrectomy in epiretinal membrane surgery

Sayed Khulood Mohammed,Naito Takeshi,Farouk Mahmoud Mohamed,Nagasawa Toshihiko,Katome Takashi,Abd El-Latif Ismail Mousa,Abdallah Ahmad Mostafa,Mohamed Usama Ali,Mitamura Yoshinori
The journal of medical investigation : JMI 59(1-2), 69-78, 2012-02
… Twenty five-gauge group achieved a significantly lower anterior chamber inflammation and a lower incidence of postoperative cystoid macular edema (CME) (p=0.01), hyphema (p=0.000) and after cataract (p=0.000) than 20-gauge group. …
NAID 120005369309

白内障術後外傷性無虹彩症の1例

三田覚,坂本拡之,堀貞夫,MITA Satoru,SAKAMOTO Hiroyuki,HORI Sadao
東京女子医科大学雑誌 82(E1), E220-E225, 2012-01-31
【目的】白内障手術後に鈍的外傷による外傷性無虹彩症を呈した症例を経験したので報告する。,【症例】59歳女性。眼既往に髄膜腫の眼窩内進展に対し放射線治療歴があり、左眼は放射線白内障および網膜症の合併がある。左眼白内障に対し手術を施行した。術14日後、左眼の鈍的外傷による視力低下にて再診した。前房出血をみとめ視力は光覚弁。手術創は閉鎖しており離解はなかった。虹彩が全周性に消失していたが眼内レンズ(IO …
NAID 110008767980

上強膜静脈圧上昇による緑内障に対する線維柱帯切開術術後に大量前房出血をきたした1例

深見光樹,家木良彰,渡邊一郎 [他]
眼科臨床紀要 5(8), 749-752, 2012
NAID 40019413244

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「前房出血」

Hyphema
	Classification and external resources
	; Hyphema - occupying half of anterior chamber of eye
ICD-10	H21.0
ICD-9	364.41
DiseasesDB	31299
MedlinePlus	001021
eMedicine	oph/765
MeSH	C11.290.484

　　[★]

英: hyphema
ラ: hyphaema
関: 前房

[Medscape-1] Sheppard, John D. "Hyphema". WebMD, LLC. Medscape. Retrieved 29 November 2012.

[Tx_TraumaticHyphema-2] Walton, William; Von Hagen, Stanley; Grigorian, Ruben; Zarbin, Marco (July–August 2002). "Management of Traumatic Hyphema". Survey of Ophthalmology 47 (4): 297–334. doi:10.1016/S0039-6257(02)00317-X. PMID 12161209. Retrieved 29 November 2012.

[3] Crawford, JS; Lewandowski, RL; Chan, W (September 1975). "The effect of aspirin on rebleeding in traumatic hyphema.". American journal of ophthalmology 80 (3 Pt 2): 543–5. PMID 1163602. Retrieved 29 November 2012.

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hyphema