Secondary Open-Angle Glaucomas
Neil T. Choplin, Carlo E. Traverso in Atlas of Glaucoma, 2014
After the first week, other factors may lead to glaucoma. Vitreous in the anterior chamber may reduce aqueous outflow. Hyphema, related to wound construction or intraocular lens position, may occur. Ghost-cell glaucoma results from long-standing hyphema or vitreous hemorrhage leading to degenerated erythrocytes, which are less flexible and block trabecular channels. Retained lens particles become hydrated and more prominent, blocking the trabecular meshwork. Postoperative inflammation related to retained lens particles, intraocular lens position, vitreous traction, and surgical trauma may become more manifest. Corticosteroid-induced glaucoma must be considered as a common source of increased IOP in postoperative patients on topical steroids. Discontinuation of steroids or a therapeutic challenge of the fellow eye with topical steroids will often aid in the diagnosis.
Trauma
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague in Paediatric Surgical Diagnosis, 2018
The ocular features of non-accidental injury are varied. Retinal haemorrhage is the most common, and is believed to be due to shaking the child. Such retinal haemorrhages are often associated with intracranial haemorrhage. Traumatic retinoschisis and perimacular retinal folds have very high specificity for non-accidental injury in the absence of a severe closed head injury such as observed with crushing injuries or falls from a significant height. Haemorrhage within the optic nerve sheath is seen rarely, and occurs with severe and generally fatal shaking injury. Hyphema and lens damage may result from direct blows to the eye. Management is usually expectant. Mandatory reporting of suspected non-accidental injury is required in most countries.
Ocular Trauma
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Hyphema (bleeding in the anterior chamber) may arise spontaneously, after eye surgery, after penetrating trauma, and most classically, after blunt force trauma. Traumatic hyphemas are more common in young males and arise most commonly after assault and athletic accidents [13]. Sequelae of hyphema include corneal blood staining, increased intraocular pressure and resultant optic atrophy, and peripheral anterior synechiae, all of which can decrease final visual acuity. Although corneal blood staining may be transient, children can develop amblyopia and permanent loss of vision even as the blood clears. Final visual acuity may also be limited by other pathology such as macular holes or TON related to the original trauma rather than the hyphema.
Epidemiology of Hyphema-Related Emergency Department Visits in The United States Between 2006 and 2015
Published in Ophthalmic Epidemiology, 2019
Sidra Zafar, Joseph K. Canner, Tahreem Mir, Divya Srikumaran, Roomasa Channa, Morton F. Goldberg, Jennifer Thorne, Fasika A. Woreta
We found that the proportion of hyphema visits presenting to the ED over weekends increased, from 32.2% in 2006 to 41.9% in 2015. Schoenfeld et al. suggested that since clinics were less likely to be open on weekends than on weekdays, it forced people to seek care for low-acuity conditions in EDs.7 Similar to the findings by Ramirez et al., who demonstrated seasonal variation in ocular trauma ED visits,8 we found hyphema to peak during the late spring and summer months of May–July. It has been speculated that as a result of warmer temperatures and the increased daylight hours, people tend to spend more time during summers, outside their homes, participating in potentially risky activities.8 Also, the fact that schools are closed during this period adds to the risk of children and young adults having increased exposure to and participation in injury-prone activities. Concurrent ocular injuries are frequently observed among patients with hyphema. Reported prevalence rates have varied between 67.0% and 92.0%.5 At 34.8%, the frequency of ocular injuries observed in our sample was relatively lower. However, posterior segment injuries, driven mainly by the high proportion of vitreous hemorrhages (15.8%), accounted for as much as 20.6% of all associated ocular injuries. As permanent visual loss is often related to posterior segment injuries, this highlights the importance of performing a thorough ophthalmic examination in all patients with hyphema.
Trends in Soccer-Related Ocular Injuries within the United States from 2010 through 2019
Published in Seminars in Ophthalmology, 2022
Parth A. Patel, Rhea Gopali, Anvith Reddy, Kajol K. Patel
Because of the non-uniform manner in which primary diagnoses were provided, many were combined into broader diagnostic categories. The most common ocular injury diagnostic categories were contusion/abrasion (36.1%) and blunt eye trauma/injury (19.9%). These were followed by irritation/inflammation (11.6%), which included iritis, iridocyclitis, and conjunctivitis, and hyphema (10.8%). Additional diagnostic categories were hemorrhage (where not specifically diagnosed as hyphema), eye pain, and retinal damage; the latter was collated to include diagnoses such as retinal detachment, commotio retinae, and retinal tear. Finally, diagnoses not in the aforementioned categories (e.g., anisocoria, bacterial keratitis, vitreous detachment, etc.,) were combined into “other” (Figure 2).
Intraocular Lymphoma
Published in Ocular Immunology and Inflammation, 2021
Emmett T. Cunningham, Elisabetta Miserocchi, Justine R. Smith, John A. Gonzales, Manfred Zierhut
Zhou et al.19 presented two patients, a 78-year-old woman and a 59-year-old man, who presented with a unilateral pseudo-hypopyon and in whom diagnostic cytologic, immunohistologic, and molecular analyses were performed on aqueous humor aspirates. The affected eye of 78-year-old patient presented with ocular hypertesion and hyphema, whereas a hyphema developed in the affected eye of the 59-year-old patient within a few months of presentation. In the female patient, histology was consistent with large B-cell lymphoma, immunohistochemical staining showed CD20+ lymphocytes, flow cytometry revealed CD19 and CD20 immunophenotypes, and molecular analyses showed IgH gene rearrangement. In the male patient, analysis revealed large, malignant lymphoma cells, an elevated IL-10:IL-6 ratio, and IgH gene rearrangement. The authors reviewed 20 previously reported cases of intraocular lymphoma with pseudo-hypopyon formation and made the observations that all but three of the 22 total cases (86.4%) occurred in the setting of systemic lymphoma; that inflammation was bilateral in 10 cases (45.5%); and that six eyes each had hyphema or increased intraocular pressure (IOP), including the two eyes of their two patients, as described above. In most of the 20 previously reported cases the diagnosis was based on histology and/or immunostaining of cells obtained from the aqueous humor.
Related Knowledge Centers
- Accommodation
- Atrophy
- Cornea
- Eye
- Glaucoma
- Intraocular Pressure
- Optic Nerve
- Anterior Chamber of Eyeball
- Iris
- Synechia