A 25-year-old is hit by a squash ball. He develops a hyphaema filling 30% of the anterior chamber. His IOP is 38 mmHg. He is of African ancestry. Which complication is he at highest risk for compared to Caucasian patients?

• A Corneal blood staining
• B Secondary glaucoma from trabecular haemosiderosis
• C Rebleeding on day 5
• D Sickle cell trait-related sickling in the anterior chamber leading to angle occlusion and optic atrophy ✓

Explanation

Patients with sickle cell disease or sickle cell trait are at greatly elevated risk of sickling of red blood cells in the relatively hypoxic and acidotic environment of the anterior chamber. Sickled cells obstruct trabecular outflow, causing severe IOP elevation. Even modest IOP elevations can cause optic atrophy rapidly due to compromised sickle cell circulation at the optic disc. The threshold for surgical intervention (anterior chamber washout) is lower in these patients (IOP > 24-35 mmHg for 24 hours, versus standard criteria).

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.