In traumatic hyphema, the management guideline that distinguishes patients with sickle cell trait from normal patients regarding IOP management threshold is:

• A The IOP target in sickle cell patients is <24 mmHg versus <30 mmHg in normal patients
• B IOP >24 mmHg in sickle cell patients requires more aggressive intervention as sickling reduces RBC flexibility causing optic nerve ischemia at lower pressures ✓
• C Carbonic anhydrase inhibitors are the preferred agent in sickle cell patients
• D Aspirin can be given to sickle cell patients with hyphema to prevent rebleed

Explanation

In sickle cell trait/disease patients with hyphema, the optic nerve and retinal vessels are at risk of ischemia at IOP levels that would be tolerated in normal patients, because sickled (deformed) RBCs impede microvascular flow even at moderate pressure elevation. Current guidelines recommend maintaining IOP ≤24 mmHg in sickle cell patients (vs. ≤35 mmHg in others). Importantly, acetazolamide (CAI) and hyperosmotic agents are contraindicated in sickle cell disease as they cause systemic acidosis and hyperosmolarity promoting sickling. Topical beta-blockers or alpha-agonists are preferred.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.