Evaluation

Taking a systemic history is especially important since hyphema is more common and potentially much more severe in patients with sickle cell disease. In addition, it needs to be known whether the patient suffers from bleeding disorders or is on anticoagulant therapy5. The slit lamp is the best tool to identify the presence and amount of blood6 (Table 2.5.3). Ultrasonography, the UBM, and radiological tests may have to be performed to determine whether there is coexisting damage to anterior or posterior segment structures. Laboratory tests should also be ordered if sickle cell disease is suspected (sickle cell preparation, hemoglobin electrophoresis, bleeding tests) or if systemic antifibrinolytic therapy is planned (kidney and liver functions).

5 Although it has not been proven that such therapy increases the risk [5].

6 This is usually not possible if the patient is in bed and the blood cannot settle.

Table 2.5.3 Various methods to describe the size of hyphema

Method

Comment

Millimeters

The height of the pooled blood is given; however, a "12-mm" hyphema is described as total

Percentage

0 if there is no blood in the AC and 100 if a total hyphema is seen

Clock hour

The face of the clock is used to describe the height of the meniscus of the blood at the limbus

Grade

I: <1/3

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