Secondary Glaucoma from Recurrent Hemorrhage in Traumatic Hyphema
Section outline
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A patient with a past medical history of recurrent deep vein thrombosis status-post inferior vena cava stent requiring apixaban plus clopidogrel and past ocular history of anterior chamber washout, pars plana vitrectomy, lens extraction is referred for worsening in elevated intraocular pressure in the left eye of 1 day to 40 mmHg. They reported blurry left eye vision of 12 weeks since a mechanical fall. At that time the patient was found to have a traumatic hyphema with intraocular pressure of 63 and shallow anterior chamber without improvement after peripheral iridotomy. They received an anterior chamber washout, pars plana vitrectomy, and lens explant. The patient was continued on topical prednisolone, brimonidine, and dorzolamide-timolol. They denied family history of sickle cell hemoglobinopathy. Exam showed left eye vision of light perception, intraocular pressure of 37, and a relative afferent pupillary defect. Anterior segment exam revealed cornea edema and cornea blood staining, grade 1 hyphema, and aphakia. There was poor view to the posterior segment, and Bscan ultrasonography revealed a flat retina with vitreous hemorrhage. The patient was taken to the operating room for an anterior chamber washout and valved glaucoma drainage implant. Their internist recommended against cessation of apixaban or clopidogrel, so care was taken to minimize intra-operative and post-operative hypotony. Post-operatively the patient continues to have light perception vision with improved intraocular pressure in the low teens and no hyphema.
Presentation Date: 09/11/2025
Issue Date: 03/06/2026
