Total Hyphema with Light Perception Vision Managed by Anterior Chamber Washout: A Case Report

Abstract

Introduction

Ocular trauma represents a major etiology of monocular blindness and visual morbidity, frequently requiring emergent ophthalmological evaluation to prevent permanent deficits.¹ Traumatic hyphema, defined as the presence of blood within the anterior chamber, typically arises from blunt or penetrating force that disrupts the vascular integrity of the iris or ciliary body.³ While most hyphemas are self-limiting, high-grade presentations (Grade III and IV) pose a significant risk for secondary complications such as ocular hypertension, secondary glaucoma, and corneal blood staining.⁵ The management of these cases is particularly complex in the immediate postoperative period following intraocular surgery, where the structural stability of the eye is already compromised.⁸

Case Illustration

A 64-year-old male presented with a chief complaint of sudden vision loss, severe ocular pain, and redness in the right eye (OD) after an accidental hand strike during sleep. The patient was one week postoperative following a Small Incision Cataract Surgery (SICS). Initial examination revealed a visual acuity of light perception (LP), an intraocular pressure (IOP) of 21.9 mmHg, and a Grade IV total hyphema with evidence of fibrin clots. Slit-lamp biomicroscopy confirmed corneal edema and a hazy anterior chamber. Despite three days of intensive conservative management using postural therapy, topical steroids, anti-glaucoma agents, and systemic antifibrinolytics, the visual acuity did not improve. Consequently, a surgical anterior chamber washout was performed.

Discussion

Total hyphema, often referred to as an "eight-ball" hyphema when clotted and deoxygenated, necessitates a careful balance between medical observation and surgical intervention.³ In this case, the recent surgical history and the stagnant nature of the clotted blood increased the risk of permanent endothelial damage and optic neuropathy.⁶ The choice of an anterior chamber washout as a minimally invasive procedure was pivotal in evacuating the blood and restoring aqueous dynamics.⁸ Pharmacological support using Indonesian-branded medications such as Bralifex Plus and Hyaloph, combined with comprehensive antioxidant supplements like Asta Plus and Retivit Plus, facilitated the recovery of the ocular surface and neuroprotection.¹³

Conclusion

Anterior chamber washout is an effective and safe intervention for non-resolving total hyphema in the early postoperative phase.⁸ Prompt surgical evacuation, when medical therapy fails to produce clinical improvement within 72 hours, is essential to prevent irreversible complications and ensure significant visual recovery.⁶