Seeing Eye to Eye with Traumatic Hyphema: Case Report and Management Guidelines

Background: Traumatic hyphema, the presence of blood in the anterior chamber of the eye, is a complication of blunt or penetrating injury to the eye, particularly in ball and disc sports. It may be associated with injury to adjacent intraocular and orbital structures. This diagnosis warrants urgent evaluation and further workup by an ophthalmologist. Aim: This report serves to examine a sporting injury that resulted in a traumatic hyphema with subsequent discussion of this type of ophthalmic injury and its management guidelines based on current literature. Case Report: We present a 16-year-old ultimate frisbee player who was struck in the face with a frisbee from arm’s length which resulted in the development of blurry vision and eye pain in the left eye. With further evaluation the player was found to have a grade 0 - 1 traumatic hyphema due to the presence of scant blood in the anterior chamber of the left eye. He was removed from play and initially managed conservatively with a clear eye shield, remaining in an upright posture, and applying no pressure to the left eye. He was then referred to a nearby level 1 trauma center for urgent ophthalmologic evaluation and treatment. Discussion: While most traumatic hyphemas are managed conservatively with bed rest, eye shields, bed elevation, and removal from sports play if applicable, medical treatments that are considered include antifibrinolytics (aminocaproic acid and tranexamic acid), antiglaucoma medications, corticosteroids, and cycloplegics. The discussion of analgesia is important as aspirin/NSAIDs should not be used or should be discontinued due to the risk of secondary hemorrhage. Instead, acetaminophen or codeine has been suggested in previous literature. Although uncommon, severe hyphemas could warrant surgical intervention and may result in vision loss or permanent ocular sequelae.