Outpatient management of traumatic hyphemas in children

Abstract

Objective: There are no outcome reports in the literature for outpatient management of traumatic hyphemas in children. Therefore we studied such cases at our institutions.

Design: Retrospective chart review.

Participants: 25 children less than 16 years of age with grade I traumatic hyphemas.

Intervention: Inactivity at home with frequent office visits to monitor progress and complications. Treatment otherwise varied but virtually all patients received protective eye shields and topical steroids.

Main outcome measures: Rate of rebleeding and final visual acuity.

Results: Three patients (12%) suffered a rebleed; one required surgery for clot evacuation. One of the three did not receive topical steroids and if he is excluded, rebleed rate is 2/24 or 8.3%. The hyphema resolved without sequelae in the other 22 patients. All patients had a final visual acuity of 20/40 or better except three patients (12%) who had concurrent vision-limiting ocular injuries and/or disease. Final visual acuity was 20/30 or better in all three patients with rebleeds.

Conclusions: Our rebleed rate was within the broad range of rebleed rates reported in the literature. However, improved efforts to identify children at highest risk for rebleeding, to maximize compliance with treatments, and to consider systemic agents in selected cases, could further reduce the rebleed rate and increase acceptance and safety of outpatient management in pediatric traumatic hyphemas.