L/O/G/O

Rince LiyantiInfection and Immunology SubdivisionDepartment of OphthalmologyAndalas University - Dr M Djamil Hospital

PATHOPHYSIOLOGY AND COMPLICATION

OF HYPHEMA

HYPHEMA

Most frequently caused by ocular trauma, after intraocular surgery, and also can occur spontaneously

Microhyphema is the red blood cells in the aqueous humor of the anterior chamber without grossly visible blood

Introduction

Definition: Blood in the anterior chamber of eye, which forming a coat which can be seen by naked eye

Introduction

The annual incidence is in Male,

between ages 10-20 years.

In this review, we’ll discuss about pathophysiology and complications of hyphema

A tear at the anterior aspect of the ciliary body is the most common site of bleeding and occurs in about

71% of cases

Anatomy

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The anterior chamber is bordered anteriorly by the cornea and posteriorly by the iris diaphragm and the pupil The anterior chamber is filled with aqueous humor.Aqueous Humor passes through the pupil to the anterior chamber, then flows to trabecular meshwork, the Schlemm canal, sclera and episclera vein.

Anatomy

IRIS

The most anterior extension of the uveal tractBlood vessels form the bulk of the iris stromaAnastomoses occur between the arterial and venous arcades to form the minor vascular circle of the irisThe major arterial circle is located at the apex of the ciliary body, not the iris

Anatomy

SILIARY BODY

The ciliary consists of 2 parts: pars plana and pars plicata The capillary plexus of ciliary process arterioles as they pass anteriorly and posteriorly from the major arterial circleThe main arterial supply to the ciliarybody comes from the anterior and the long posterior ciliary arteries.The major veins drain posteriorly through the vortex system

Pathophysiology

Compressive force to the globe or trauma

Injury to the iris, ciliary

body, trabecular

meshwork, and their associated

vasculature

Accumulation of blood cells

within the anterior chamber

Mechanism of Traumatic Hyphema

Pathophysiology

Pathophysiology

Surgery (Intraoperatif, early, late) : Trauma directly in the siliar body and iris, dilatation

of the vessel post surgery

Spontan Hyphema : Iris vessel fragility, so the minortrauma might precipitate hyphema, or in

patientsusing drugs that alter platelet or thrombin function

Hyphema is classified by the amount of blood in the anterior chamber

Classification

Complication

Increased Intraocular Pressure

IOP is increased because of : Occlusion of trabecular meshwork by clot, inflammatory

cell or RBC debris Pupillary block due to blood clot Peripheral anterior synechiae Other late causes : damaged trabecular meshwork with

angle recession, fibrosis of trabecular meshwork, siderosis of trabecular endothelium and ghost cell glaucoma

Secondary Hemorrhage/ Rebleeding

Complication

Usually occurs on the third day or the fourth day, but it may occur from the second day to the seventh day after trauma

Size of the hyphema increases A layer of fresh blood is looked over the clot Darker clot in the anterior chamber Dispersed of the erythrocytes appear over the clot

Complication

Posterior and Peripheral Anterior Synechiae Persistence of the hyphema for more than 9 days

formation of peripheral anterior synechiae (PAS).

Synechia formation is the result of inflammation or clot organization

Complication

Corneal Bloodstaining• Corneal bloodstaining tends to occur in

the larger hyphemas, rebleeding, prolonged clot duration, sustained increased intraocular pressure, and corneal endothelial cell dysfunction

• The earliest sign of corneal bloodstaining is a straw yellow discoloration of thedeep stroma

Complication

Optic AtrophyIn the setting of traumatic hyphema, optic atrophy tends to occur as a result of elevated intraocular pressure or due to optic nerve contusionThe risk optic atrophy related to elevated intraocular pressure if remain at > 50 mm Hg for 5 days or > 35 mm Hg for 7 days

80%

9%

30%

55%

Hyphema most frequently caused by ocular trauma, after intraocular surgery, or spontaneously

1

Mechanism of Hyphema is the compressive force to the globe or trauma will make the injury to the vessel, and the accumulation of blood cells within the anterior chamber

Conclusion

Bleeding generally occurs from : major arterial circle and branches of the ciliary body, choroidal arteries, ciliary body vein, iris vessels

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4 Complication : Increased Intraocular Pressure, secondary hemorraghe, posterior synechiae, peripheral anterior synechiae, corneal bloodstainning

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