hyphema

Two weeks ago my 13 year old son was injured in a baseball game.  While attempting to bunt the ball fouled off into his eye.  He immediately had very limited vision and was taken to the local ER.  He was diagnosed with a hyphema and a slight fracture to the nose (via CT scan).  Initially he was treated with timoptic .25% (BID)and pred forte (QID) His eye pressure in the ER was 23.  He was seen daily by an opthamologist and on day 2 or 3 his pressure went down to 14.  They stopped the Timoptic and continued him on the steroid.  He was seen daily and on day 6 his pressure went up to 30.  He was changed over to Durezel(QID) and Xalatan (QD).  During this time the pressure stayed between 25-29.  He is now on the Durezol twice daily, it is being tapered and Timoptic .5% in the AM and Xalatan in the evening.  Also of note he was on bedrest (strict through day 5).  By day 7 all blood was reabsorbed and the clot was gone....he was cleared to play ball around day 10 with protective goggles and a face mask on his batting helmet.

My questions are as follows.

His pupil is quite large in comparison to the uninjured eye, will this ever resolve?
How long can a child (with no other health issues) sustain an elevated pressure such as this?
Is the elevated pressure more likely to be related to the steroid drop of the injury itself?
Since the pupil is so large will he always need sun protection?

He is in no pain and seems unbothered by the whole incident but I as a parent and concerned regarding the issues above.

Thank you

[Sandy Feldman, MD, MS]

Dear sue3708,

The enlarged pupil may be a result of the injury to the iris muscles.  It may not change.  How long the eye can tolerate these pressures can be variable from person to person.  Usually, a young person would be able to tolerate these pressures; however, it is important to have them monitored closely and addressed.  The elevated pressure can be a result of the injury or the steroid and only time will tell which is the cause.  Try to take one step at a time and communicate each of these excellent questions with his eyeMD.  The doctor knows your son’s eye and will be able to advise better.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California