W. Va. Code R. § 85-20-27

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 85-20-27 - Treatment Guidelines: Hyphema

27.1. Hyphema is bleeding within the anterior chamber of the eye, typically caused by a severe blunt trauma to the eye rupturing intraocular blood vessels. Hyphema may be associated with disruptions of the trabecular meshwork and lead to angle recession glaucoma. Early complications include elevated intraocular pressure causing blood staining of the cornea, vision loss, and most significantly, rebleeding which will occur in up to 30% of the cases within the third to fifth day. Rebleeding may cause marked elevation of intraocular pressure, corneal blood staining and visual loss. Late complications may include angle - recession glaucoma and cataract. Injured workers at considerable risk for complications include those with sickle cell or other coagulopathy.

27.2. Diagnostic criteria consist of a history of a blunt trauma to the eyes. The physical findings may include red blood cells visible within the anterior chamber, a layered clot filling the entire anterior chamber and/or intraocular pressure elevation.

27.3. The appropriate diagnostic tests and examinations are as follows:

a. Immediate referral to an opthalmologist as this is an ocular emergency;

b. A comprehensive examination by an ophthalmologist including a slit lamp exam, determination of the intraocular pressure, and a dilated fundus examination if possible;

c. Orbital x-rays may be indicated to rule out other orbital injuries; and

d. A platelet count and coagulation study as indicated as well as a sickle prep, and hemoglobin electrophoresis as indicated.

27.4. Appropriate treatment is as follows:

a. Outpatient treatment is indicated if the hyphema is not severe, there are no complications present and the injured worker is reliable. Treatment consists of the following:

1. Strict bed rest for five days;

2. Daily eye examination;

3. Medication, which may include the following: topical cycloplegics, steroids, ocular hypotensive and oral prednisone and/or aminocaproic acid;

4. Hard shield to be worn day and night; and

5. A gonioscopy after 2-3 weeks.

b. Inpatient treatment is indicated for significant hyphema, marked intraocular pressure elevation, complication or unreliable care and consists of the following:

1. Medication as noted for outpatient care;

2. Hospitalization with strict bed rest for five days; and

3. Surgical evacuation of the clot.

27.5. Return to full work is anticipated in three weeks for uncomplicated cases. Evidence of disruption of intraocular structures dictates lifetime monitoring for glaucoma and cataracts.

27.6. The anticipated outcome is resolution of the hyphema with return of visual acuity.

W. Va. Code R. § 85-20-27