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Evidence summaries

Medical Interventions for Traumatic Hyphema

Antifibrinolytic agents or other medical interventions appear not to have an effect on the final visual acuity in traumatic hyphema. Antifibrinolytics appear to reduce the rate of secondary hemorrhage. Level of evidence: "B"

A Cochrane review [Abstract] 1 on various medical interventions in the management of traumatic hyphema included 27 studies (20 randomized, 7 quasi-randomized) with a total of 2 643 subjects. Interventions included antifibrinolytic agents (oral and systemic aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest. No intervention had a significant effect on visual acuity whether measured at two weeks or less after the trauma or at longer time periods. The number of days for the primary hyphema to resolve appeared to be longer with the use of aminocaproic acid compared to no use, but was not altered by any other intervention.

The rate of recurrent hemorrhage was reduced by systemic and topical aminocaproic acid (OR 0.25, 95% CI 0.11 to 0.57 and OR 0.42, 95% CI 0.16 to 1.10, respectively) as well as by tranexamic acid (OR 0.25, 95% CI 0.13 to 0.49) and aminomethylbenzoic acid (OR 0.07, 95% CI 0.01 to 0.32). The evidence to support an associated reduction in the risk of complications from secondary hemorrhage by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compared with placebo.

No difference was found in effect between a single versus binocular patch nor ambulation versus complete bed rest on the risk of secondary hemorrhage or time to rebleed.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).

    References

    • Gharaibeh A, Savage HI, Scherer RW et al. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev 2013;(12):CD005431. [PubMed]

Primary/Secondary Keywords