Hyphema, or bleeding into the anterior chamber (AC) of the eye, may occur after trauma. The risk of secondary bleeding can be predicted if the status of 4 risk factors is known. This can help decide whether or not to treat prophylactically, with those at high risk likely to benefit.
|
Risk Factor |
Finding |
Odds Ratio from Multivariate Logistic Regression Analysis |
|---|---|---|
|
visual acuity |
20/200 or less |
2.4 (1.0 - 5.8) |
|
hyphema grade at presentation |
Grades 2, 3, 4 |
1.9 (0.6 - 5.7) |
|
delay in treatment |
> 1 day |
2.7 (1.0 - 7.5) |
|
intraocular pressure at presentation |
>= 21 mm Hg |
2.9 (1.1 - 7.6) |
from Table 3, page 1586
where:
• Visual acuity is described in the paper using ">=" and "<=". These do not appear to be consistently used in Figures 2, Table 3 and Table 6.
|
Extent of Bleeding |
Grade of Hyphema |
|---|---|
|
less than one third of the anterior chamber (AC) |
1 |
|
one third to one half of the AC |
2 |
|
one half to three quarters of the AC |
3 |
|
more than three quarters of the AC |
4 |
defined page 1584
number of risk factors =
= SUM(number of findings present)
Interpretation:
• If no risk factors are present, then the risk of secondary hemorrhage is 5%.
• If at least one risk factor is present, then the risk of secondary hemorrhage is 2-3 times greater..
|
Visual Acuity |
Grade |
Delay |
Pressure |
Risk of Secondary Bleeding |
|
20/100 or better |
1 |
<= 1 day |
< 21 mm Hg |
5% |
|
|
1 |
<= 1 day |
>= 21 mm Hg |
12% |
|
|
1 |
> 1 day |
< 21 mm Hg |
11% |
|
|
1 |
> 1 day |
>= 21 mm Hg |
27% |
|
|
>= 2 |
<= 1 day |
< 21 mm Hg |
8% |
|
|
>= 2 |
<= 1 day |
>= 21 mm Hg |
21% |
|
|
>= 2 |
> 1 day |
< 21 mm Hg |
20% |
|
|
>= 2 |
> 1 day |
>= 21 mm Hg |
42% |
|
20/200 or less |
1 |
<= 1 day |
< 21 mm Hg |
11% |
|
|
1 |
<= 1 day |
>= 21 mm Hg |
26% |
|
|
1 |
> 1 day |
< 21 mm Hg |
24% |
|
|
1 |
> 1 day |
>= 21 mm Hg |
48% |
|
|
>= 2 |
<= 1 day |
< 21 mm Hg |
18% |
|
|
>= 2 |
<= 1 day |
>= 21 mm Hg |
40% |
|
|
>= 2 |
> 1 day |
< 21 mm Hg |
40% |
|
|
>= 2 |
> 1 day |
>= 21 mm Hg |
64% |
after Table 6, page 1588
Purpose: To determine the risk of secondary bleeding into the anterior chamber for a patient with hyphema after ocular trauma.
Specialty: Ophthalmology, Emergency Medicine, Surgery, general
Objective: risk factors
ICD-10: S05,
