Traumatic hyphema (blood in the anterior chamber) following blunt ocular trauma is most dangerous on which day post-injury, and why?
- A Days 2–5, due to secondary hemorrhage (re-bleed) from fibrinolysis of the initial clot before revascularization is complete ✓
- B Day 1, due to the initial hemostatic plug being absent
- C Day 7, due to inflammatory glaucoma from hemolytic products
- D Day 14, due to rubeosis iridis (neovascularization of iris)
Correct answer: A. Days 2–5, due to secondary hemorrhage (re-bleed) from fibrinolysis of the initial clot before revascularization is complete
Explanation
Secondary hemorrhage (re-bleed) in traumatic hyphema typically occurs on days 2–5 post-injury when fibrinolytic activity peaks and dissolves the initial clot before the ruptured blood vessel has healed. Secondary hemorrhage is more dangerous than the primary hyphema as it tends to be larger, causes acute IOP spikes, corneal blood staining, and prolonged anterior chamber reaction. Management strategies to prevent secondary hemorrhage include bed rest, eye shield, avoiding aspirin/NSAIDs, and aminocaproic acid (antifibrinolytic) in high-risk patients.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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