A 30-year-old man presents with a history of blunt trauma from a fist to the left eye 2 hours ago. VA is 6/60. Slit-lamp shows 8-ball hyphema (total hyphema filling the entire anterior chamber). IOP is 52 mmHg. The most concerning systemic complication to screen for in this patient is:
- A Commotio retinae
- B Angle recession glaucoma
- C Sickle cell disease or trait ✓
- D Sympathetic ophthalmia
Explanation
Sickle cell hemoglobin (HbS, HbSC, or sickle trait HbAS) significantly worsens hyphema prognosis. Sickled erythrocytes are rigid and obstruct the trabecular meshwork, causing severe uncontrolled IOP elevation at relatively smaller hyphema volumes. The threshold IOP for anterior segment ischemia and optic nerve damage is lower in sickle cell patients. Additionally, certain hyphema treatments (aminocaproic acid, systemic carbonic anhydrase inhibitors) are contraindicated in sickle cell disease. Sickle cell screening is therefore mandatory in all hyphema patients, especially those of African descent.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.