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Q J Med 2015; 108:593 doi:10.1093/qjmed/hcu244 Advance Access Publication 18 December 2014 Clinical picture Secondary hemorrhage in traumatic hyphema the blood. Topical atropine (in order to reduce iris movement) and steroids (inhibiting fibrinolysis) were given with IOP lowering therapy. A work up was performed including: complete blood cell count, activated partial thromboplastin time, prothrombin time, all of which were unrevealing. The ocular echography excluded other associated ocular lesions (traumatic cataract, retinal detachment, vitreous hemorrhage). The uncontrolled IOP (within 48 h) required a surgical evacuation with a favorable postoperative evolution. The patient regained progressively a visual acuity of 10/10 within 2 weeks. Photographs and text from: Z. Hafidi, Y. Amrani, S. Berradi, H. Handor and R. Daoudi, Faculty of Medicine, Department A of Ophthalmology, Teaching Hospital of Rabat, University of Mohammed V, Rabat, Morocco. email: [email protected] Conflict of interest: None declared. References 1. Walton W, Von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol 2002; 47:297–334. 2. Lai JC, Fekrat S, Barron Y, Goldberg MF. Traumatic hyphema in children: risk factors for complications. Arch Ophthalmol. 2001; 119:64–70. Figure 1. Slit lamp examination of the right eye showing a multilayered hemorrhage of the anterior chamber (hyphema), with a dark clot (white arrow) overhung by a layer of fresh blood (empty arrows). ! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected] Downloaded from by guest on October 20, 2016 A 40-year-old man presented with 3 h history of acute painful vision loss of his right eye. He reported a blunt trauma of the same eye 7 days prior to admission. At examination his visual acuity was reduced to light perception. Slit lamp examination revealed a multilayered hyphema (collection of blood in the anterior chamber). A layer of fresh blood (empty arrows) was noted over the darker clot (white arrows) in the anterior chamber (Figure 1). The intraocular pressure (IOP) was increased (40 mmgh). Hyphema is usually caused by blunt or penetrating ocular trauma. Spontaneous hyphema may occur as well (iris neovascularization, intraocular tumors . . .). Rebleeding after traumatic hyphema occurs classically in the first week after the first hemorrhage. Besides the importance of hyphema, rebleeding is one of the main prognostic factors which are generally associated with a poor functional result. It must be suspected if the size of the hyphema increases or if a supernatant of red clear blood is noted over the older clot in the anterior chamber.1 Untreated it may lead to complications2 such as increased IOP, corneal bloodstaining (hematocornea) and optic atrophy. So it is reasonable to consider the predisposing factors in the management of this condition like: Clotting and blood disorders (hemophilia, sickle cell anemia), uncontrolled hypertension or induced hypertension (physical effort), marked ocular hypotony, clot dissolution. Thus our patient was placed at bed rest with head end elevation in order to facilitate inferior settling of