***** ANSWER *****
Layered traumatic hyphema of the right eye:
Hyphema, or blood in the anterior chamber, is
usually the result of external trauma or
surgery. It can also occur in the absence of
trauma, eg, in patients with iris
neovascularization after central retinal vein
occlusion or related to diabetes mellitus. In
rare cases, hyphema may be a sign of an iris
tumor.
In this case, the blunt blow to the eye
ruptured a blood vessel of the iris, causing a
small amount of blood to leak into the anterior
chamber. Initially, the blood was dispersed within
the aqueous humor, but over the next few hours, the
blood settled into layers within the inferior
portion of the anterior chamber. Typically,
when the person is recumbent (eg, during sleep),
any blood remaining in the chamber again mixes
with the aqueous humor, causing blurred vision
at the time of wakening.
Traumatic hyphema may be associated with many
other injuries to the eye, depending on the
nature and severity of the blow. Injury to the
iris musculature that causes traumatic
iridoplegia may be present, as in this case.
This injury manifests as a slightly dilated and
sluggish pupil. In the absence of rebleeding,
most hyphemas spontaneously clear within a few
days.
Treatment includes avoidance of any physical
activity that might cause rebleeding; the
application of topical corticosteroid eyedrops
to reduce inflammation of the iris and ciliary
body; and, occasionally, the use of cycloplegic
drops to relieve ciliary spasm or prevent
adhesions from forming between the iris and the
anterior lens. Bed rest is not necessary in
uncomplicated cases.
All patients with traumatic hyphema should
undergo ophthalmologic examination after the
hyphema has cleared to rule out peripheral
retinal tears and damage to the anterior
chamber angle.
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