Protocol for Hyphema management

Protocol for Hyphema management
1. General measure like councelling regarding bed rest , head end elevation and
recoverable nature of the condition.

2. Medical treatment with focus on

i.For blood drainage
ii. For IOP

A. For Blood drainage, start

1. topical medication including
g.CYCLOPEN B.D
g.PREDFORTE QID to 1 hourly depending upon ciliary flush, deep pain.
(Remember to taper steroids as resolution of symptoms start)

2. Oral Analgesics like Tb. Paracetamol BD

B. For IOP lowering, start

1. g. Alphagan TDS
(If IOP not controlled then start)

2. Oral Acetazolamide 15mg/kg QID
3. IV Inj 20% Mannitol 1-2g/kg/dose in 3 divided doses.

Follow Up.

1. Grade of hyphema
2. IOP
3. BP
4. Pulse
5. Urine output
6. Renal functions

In following conditions do surgical intervention for hyphema drainage.

1. Hyphema not decreasing to 50% after 8 days (to prevent PAS)

2. Any IOP with corneal staining

3. For IOP >60mmHg for 2 days ( to prevent optic atrophy)

4. For IOP >25 for 5 days ( to prevent corneal staining)

5. For IOP > 24 for 24 hrs ( in sickle cell disease)