Grand Rounds
A child presented to the children’s hospital emergency room with blurred vision in the left eye, somnolence, and nausea after trauma of the left eye with a foam pellet toy gun. The intraocular pressure was 40mmHg on initial presentation and despite topical therapy was 46mmHg 3 hours later. The vision was decreased to 20/100. A thorough medical history revealed that the patient had sickle cell trait, and thus given the elevated intraocular pressure the patient was taken for urgent trabeculectomy without mitomycin C. This case highlights the management of traumatic hyphema with elevated intraocular pressure, and it illustrates nuances of treating patients with sickle cell trait and sickle cell disease. Sickle cell trait and disease can predispose to increased IOP, risk of rebleed, optic nerve atrophy, and retinal ischemia. In sickle cell patients, indications for surgery include IOP ≥ 25mmHg for ≥ 24hr or intermittent spikes above 30mmHg. Anterior chamber washout, trabeculectomy ± MMC , or glaucoma drainage device may be appropriate surgical choices, although additional research is needed to guide management.
Presentation Date: 03/06/2025
Issue Date: 05/16/2025
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