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The Joys of Hyphema

I like to play a lot of ball hockey, and I play on a lot of different levels (from fun to high level). Anyways, I was playing some hockey for fun with some friends in small gym. Luckily (I think), we use a taped up light wiffle ball on these night as opposite to the normal heavy orange ball.

So its Thursday, I ended up getting an errand ball from 5 feet away straight into the eye. After a minute of pain on the ground, I looked and saw nothing but red. I thought "oh ****, there goes my eye". Went to the bathroom, but other than being red looked ok. Decided to drive to the ER (with one eye, fun) and have it checked out. They took me in right away which was either good or bad. At this point I could see light, some movement, and colors. After being looked at, they tell me its a minor Hyphema and about 15% (blood) filled, and my pupil isn't doing anything. I get sent home, to see a specialist Saturday.

That night (Thursday still) I see a marked improvement by mid-night (3 hours afterwards) I can see things now from a 20 feet away. Not well, but I can see them now at least (feeling positive). Very light sensative, hurt to look at anything that had light. Hurts to look around in general.  

I sleep elevated that night, I wake up and I see another marked improvement. Through the day it continues to the point where I see quite well towards the end of the day as long as I stay still and didn't look around to much. If I did it was like kicking up a dust storm, and it would haze over. I'm also noticing that my pupil is now moving (not fully, but moving). Hurts to look around still.

Now its Saturday, wake up drive for a few hours to see this specialist. Today I needed pain meds, the eye really hurts to move around. I get there and he tells me, again. Minor Hyphema, 3 small tears that he can see. Gives me the dilating drops, as well as the milky inflammation drop.  Pressure is under 20 btw. No Retina problems or tears inside (good to hear). I notice my eye goes back to normal in at least 6 hours, and now I can focus up close again. Wife is driving (now dark) and I'm feeling good about my vision (car lights not bothering me a ton). I look at the eye before bed and the pupil is moving a lot more (but still not fully). The Haze isn't to bad at all (when still pretty clear) unless I'm doing a lot of moving around again. Light sensitivity is down to almost none. I was given 1% Cyclogyl to take once before bed for 3 days, and the inflammation drop to take regularly for a while. I'm told I can sleep in my bed, no elevation needed.

Its now Sunday, my vision seems very slightly worse today. Basically there seems to be more of a permanent haze that doesn't settle as easily as it did before when I was moving. Little concerned, but can't do nothing more than wait, and I feel like this might be from not sleeping elevated (little mad) Noticing lights have a bigger haze, kind of like the orange around them extends to a larger circle, difficult to explain. pupil is moving well, but not to the full range. I take the Dilating drop at mid-night, notice the pupil go huge.

Its now Monday, I slept elevated for most of the night, went to bed for the last hour. When I wake up at 8. Right eye very foggy, and the pupil is still huge (little concerned, why did it go away so quickly on Sat). Very light sensitive, and unable to see up close like before  (but this is the drops fault I know). Its now 12 noon, pupil still big, but the haze seems to have lifted somewhat from sitting here (which makes me feel better). Visually, I can only see a sliver of the blood left in my eye so it must be re-absorbing although it was pretty hard to see from the start. Moving the eye around feels good. That's where I'm at now.

I was very surprised the specialist gave me the ok to play hockey this Saturday. I thought I was not going to be able to make the Tourney, but it makes me feel like the injury isn't to bad.

Concerns right now are
1. when this hazing over will stop. Its frustrating to go from decent to hazzy whenever I go anything.
2. These dilating drops scare the crap out of me!

I thought I'd share my expierence, since my vision has been an expierence of bad to varing degree's of acceptable.  
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177275 tn?1511755244
This type of injury does not lend itself to generalizations or standardized testing because each of these injuries are unique. So no figure can be given for traumatic cataracts/glaucoma/retinal detachment.

The side effects of steroids causing cataracts comes from long term use say greater than 6 months. Its the same way with oral steroids.  Steroid dose packs are used for things like poison ivy for a week or so without little risk. On the other hand anyone on oral or eye drop steroids for a year will likely have some side effects.

JCH MD
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1 Comments
Interesting, thanks
177275 tn?1511755244
Okay glad you've done well. wear proper eye protection for all contact sports and racket sports and other activities with high possibility of injury e.g. mowing, weed eater, power tools, etc.  Many eye trauma events don't have a happy ending. Thanks for the follow up
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Avatar universal
So I thought I'd do a follow up since my injury 7 months ago.

Vision is good, 20/20 with my regular glasses.

Those flashes stopped my last post, no floaters or further issues.

Pupil did most of its recovering at around the 3 month mark. Somewhere at the end of Feb, but continued to improve tiny bits after that too. Its now probably 90% - 95% back to normal, and I cannot see a difference anymore most times in the mirror, and visually I can't tell at all.

Pressure as of this week (had a check-up) was 17/18 in both eyes, and the eye itself looks very good according to the Doc.

One interesting thing did occur however, my prescription has dialed back. As in, improved. I had felt a difference months ago so that explains a little.
Doctor said he suspects it has to do with some sorta muscle that usually tends to drop off at 45 for everyone, that might have started that process early from the Trama. Something to that effect.  Wasn't enough to worry about changing my prescription though.



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177275 tn?1511755244
Protect your eye from another injury   JCH MD
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Avatar universal
So I went back to the 15th, pressure down to 19

Vision is back to where it was

Doc said eye is probably 85% there. Still a little mad at me.

The little flash I was having, dimmed out, and then disappeared with the odd dim flash every once in a blue moon.  

pupil remains offset. It will fully close in the sunlight, and fully open at night. Haven't noticed any improvement over the last few weeks so it wouldn't shock me if it remains that way although I know there is still room for that to improve.

Dry sticky eyelids/eyes finally feel good this week. Could have been a side effect of the Pred-Fort he thinks, but also could be other factors including the cold weather as well. Used Gel drops at night, and that's really helped.

Anyways, this will be my last post on here unless something else occurs worth updating about. Hopefully it help anyone else who comes across it.  
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177275 tn?1511755244
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Avatar universal
Little Update today

Pressure in right eye 27-28
Pressure in left eye 19-20

So on the 14th it was: 19,
On the 19th is was: 31,
and today its: 27.

Glad to see it declining. Will be going back next week to check my vision. Its better than before, but I feel at very far distances its weaker. Pupil is moving pretty good now, it will go pretty small 2-3mm, but its lazy and doesn't want to react as quick, but I'm pretty happy overall right now. Feeling pretty lucky :)
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177275 tn?1511755244
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Avatar universal
Off the Pred today (yay, really tired of dry eye/eyelids)

So different question all together. What is the percentage chance of cataracts with this type of injury? Does that percentage change with the degree of trauma?

If Traumatic cataracts do present themselves how fast do they develop or can that vary as well?

Lastly, out of curiosity. I read that steroids can trigger or bring the onset of cataracts why is this then given for injuries ? and is there no other way to control inflammation? or is the other kind of steroid that they are referring too?

Thanks in advance.
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177275 tn?1511755244
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Avatar universal
ok, thanks. I can't tell if its because of the Pred, but yah something is still off. I did a printable acuity eye test, and I still see 20/20 from both, but looking around things are blurry at distance. I can't really make sense of it. Going to see the optometrist again Thursday.
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177275 tn?1511755244
This type of injury should not change your glasses RX. If your distance vision is blurred I would see one of the doctors following your eye injury

JCH MD
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Avatar universal
At what point does a person need to go back to get their prescription rechecked? I know its to soon yet at 11 days post. Not sure what kind of time frame is needed for this kind of injury.

No problems after this weekend, no more halo's at night, no sun sensitivity, and no issues with hazing over anymore. Pupil is still a little off from the other but I've adjusted to it I think. Just blurry at a distance now.
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177275 tn?1511755244
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Avatar universal
So optometrist visit was very positive.

Said everything looks much better than he expected from the report he had, and that it all looked very good. Had some concerns over the pressure of out the eye (now 31 from being under 20), but said it was likely the Pred, and wants to dial me off it quicker, and retest the pressure next week to see what it looks like.

Also said I'd be good to play this weekend as well.
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177275 tn?1511755244
If flashes or new floaters occur anytime in the future the eye needs to be checked with dilation. The fact there were no retina tears does not mean that ones or a retinal detachment could not develop down the road. JCH MD
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Avatar universal
Now 11 at night (Wed) , so vision improvement for sure, but a couple new things.

Experiencing dry eye or eyelid? feels more like the eyelid part .... all day. Really bizarre feeling. pharmacist said it is a side effect prednisolone. So I picked up some eye drops to help. Also having a little pressure down the bridge of my nose just this evening.

Second, I think I'm also experiencing flashes in the bad eye, very bottom, light a quick flash from left to right. Very infrequently, and only very late at night. Maybe 2-3 times last night, and 3-4 tonight so far. ophthalmologist commented 5 days ago that the Retina looked good and there was no tears inside. Will mention it to the optometrist tomorrow morning when I'm there. Curious...
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177275 tn?1511755244
Yes Yay.
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Avatar universal
10am, The sun came out, and I can handle it inside or outside even coming off the snow. Light Sensitivity way down I'd say. Thinking this is due to my pupil being a bit smaller today? Either way, yay!
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Avatar universal
synechae, that looks horrible :)

Thanks for the info Doctor. Hopefully this will help other readers as well. Things that aren't well explained elsewhere !!! This board and forum has been the most helpful thing on the net. Thank you.

Day 5 at night, able to finally drive today, felt a little off during the day, but not bad at all. Sunglasses do help calm the effect down. Also drove at night time is much easier outside of all the halo's on every light.

Day 6 now, and the Pupil looks like where it was before the drop. Still larger, but not as notable. Not sure if this is from the Cyclogyl finally out of the system or because its healing very slightly from the last two days. looks like a 1mm - 1.5mm difference at this point in more aggressive light.

Clarity this morning seems again slightly improved compared to other mornings. The last few mornings I would wake to more a haze that would settle after a couple hours to the sort of vision I'm experiencing this morning already. Not sure how it'll be if I start to look down and move around yet. Other than Dry eyes at night, feels good. Despite the Doc telling me I didn't need to sleep elevated all the info online suggests the opposite so I've continued to do that, but unsure of when to stop.
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177275 tn?1511755244
Dilation:  Think about how broken bones are cast and injured joints are splinted. The dilation "rests and immobilizes" the iris, reduces the chance of rebleed, helps with prevention or treatment of traumatic iritis and reduces inflammation, also helps prevent the iris from scarring to the lens and getting scarred shut (synechae).

The blur at near could be due to the injury, the pupil not working normally and/or some blood still in the anterior chamber.

The optom will need to sort through the possible causes.

JCH MD
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Avatar universal
Thanks for the info :)

I've been doing a lot of reading on the subject trying to understand, but wasn't sure what to expect on the followup down the line so this is good to know.

I'm going in on Thursday to have it looked at again by an optometrist I trust. Then again to have it looked at Mid-april (about 5 months) a little sooner than the 6 months I was recommended by ophthalmologist.

May I ask, what is the purpose of dilation is? It seems common practice to look at the eye, but for the injury is it to help the inflammation?, reduce the chance of re-bleed?, help with re-absorption?  

The second question is, the issue with my eye fogging over. I'm at the point now where if I sit for 15 minutes or so my vision is very good, outside of near sided focus and light issues. However, if I move around esp looking down at things, it fogs up. Is this still from the blood getting kicked up? should I be concerned over this or is this something that just needs time?



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177275 tn?1511755244
Your treatment was really less that what's usually done. For a number of years I gave a lecture at a local medical school on treatment of hyphema. Usually a very strong dilation drop (atropine or homatropine) is used to completely dilate the eye and keep it dilated for 7 days and it usually takes another 7 to completely wear off.

Because of the hyphema your eye is at higher risk for traumatic retinal detachment, traumatic cataract and traumatic glaucoma.

At some point in the next couple of months your pupil need to be widely dilated and the peripheral retina checked to be sure no holes, tears, retinal detachments or a type of tear at the retina periphery called a dialysis. Also you need a test called gonioscopy to see if the drainage angle of the eye was damaged (angle recession).  If it has been torn the risk of glaucoma down the road about be 5-10%.  You also need a baseline glaucoma set of tests: visual fields, optic nerve OCT, cornea pachymetry to be used to see if any further changes down the road.

Lastly hyphema's are sometimes associated with tramatic iridoplegia where the pupil remains larger than the uninjured eye and does not react like before the injury.  

I would strongly suggest you read this article carefully on the treatment and follow up of hyphema:   http://www.emedicinehealth.com/hyphema_bleeding_in_eye/article_em.htm#hyphema_bleeding_in_eye_overview
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Avatar universal
2:00 now. Scheduled an appt with my local optometrist for Thursday. Someone I trust. Get a 2nd opinion, and another look :)

The fog that picks up if I start doing to much is still the most frustrating part outside of the light issues, and up close focus. I am hoping despite most of the blood being visually gone that its just that, and it'll go away.

No re-bleed issues, day 5 now, yay.
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177275 tn?1511755244
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