A young lady presents to your ED a few hours after a fist fight, c/o L-eye pain. She does not wear contacts and has tried ice and ibuprofen for the pain but noticed her eye was very red, so she came in for help. You do a complete eye exam, including visual acuity and a slit lamp exam; she has a hyphema that takes up half of the anterior chamber. Her IOP is 15. She says it was this size a few hours ago, also. How do you prevent the re-bleed, which carries the higher risk of blindness?
Recommend bed rest and light activity; no reading/texting.
Elevate the head of the bed, as if she is intubated.
Place an eye shield to prevent eye rubbing.
Administer amicar and atropine eye drops.
If her IOP was elevated, you’d need to lower it w/medications, like timolol.
D/w ophtho to arrange solid follow up.
Ref: http://blog.ercast.org/2011/10/hyphema/
