Traumatic Glaucoma

Traumatic Glaucoma

Angela V. Turalba

Mary Jude Cox


Following ocular trauma, patients often develop difficulties with intraocular pressure control. Intraocular pressure may be elevated or the eye may be hypotonous. Patients may have difficulty acutely or many years following the injury. In either case, a thorough history and examination will often determine the cause and severity of the intraocular damage and the appropriate course of treatment and follow-up. Open and closed globe injuries can result in damage to any of the ocular structures. This chapter focuses on traumatic hyphemas, angle recession, and cyclodialysis clefts.


The term hyphema refers to the blood in the anterior chamber. The amount of blood may be microscopic, termed microhyphema, visible only at the slit lamp as nonlayering red blood cells in the aqueous. Red blood cells may also layer or form clots in the anterior chamber (Figs. 16-1, 16-2 and 16-3). As the blood clears from the anterior chamber, it will settle in the angle and is only visible on gonioscopy. A total hyphema refers to layered blood filling the entire anterior chamber (Fig. 16-4). A total hyphema that has clotted and appears black in color is referred to as an eight-ball hyphema (Fig. 16-5). A traumatic hyphema can result from either blunt or penetrating injury to the globe. The majority of hyphemas resolve gradually without sequelae; however, complications such as rebleeding, increased intraocular pressure, and corneal blood staining (Fig. 16-6) can occur. After a hyphema clears, traumatic cataracts and iris damage become more apparent (Figs. 16-7 and 16-8).


• Traumatic hyphemas are most common in young active men, with a male-to-female ratio of approximately 3:1. In general, the risk of complications such as rebleeding, uncontrolled intraocular pressure, or corneal blood staining increases with the size of the hyphema. Patients with sickling hemoglobinopathies, however, are an exception. These patients are at an increased risk of developing complications regardless of the size of the hyphema.

• Rebleeding occurs in up to 35% of patients. The majority of rebleeding episodes take place within 2 to 5 days of the initial injury. Rebleeding is often larger than the original hyphema and more prone to complications.

May 4, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on Traumatic Glaucoma

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