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. Author manuscript; available in PMC: 2012 Sep 10.
Published in final edited form as: Cochrane Database Syst Rev. 2011 Jan 19;(1):CD005431. doi: 10.1002/14651858.CD005431.pub2

Table 8.

Initial hyphema severity

Study Severity scale Reported severity Secondary hemorrhage Other outcomes
Oral aminocaproic acid versus control
Christianson 1979 NR NR NR Time to resolution of the primary hyphema was significantly longer (P < 0.05) for patients receiving drug in which the hyphema filled more than ½ of the anterior chamber
Crouch 1976 Blood filling < ⅓ of anterior chamber Reported no statistically significant differences across groups NR NR
Blood filling ⅓ to ½ of anterior chamber
Blood filling > ½ to ¾ of anterior chamber
Blood filling > ¾ to total of anterior chamber, but excluded total hyphema
Kraft 1987 Blood filling < ⅓ of anterior chamber 30/49 (61%) study participants; 13/24 (54%) in drug group; 17/25 (68%) in placebo group 1/3 (33%) secondary hemorrhage (in placebo group) Excluding secondary hemorrhages, mean time to resolution of 3.4 days in drug group (range 1 to 11 days); mean time to resolution of 2.2 days in placebo group (range 1 to 4 days)
Blood filling ⅓ to ½ of anterior chamber 14/49 (29%) study participants; 9/24 (37.5%) in drug group; 5/25 (20%) in placebo group 1/3 (33%) secondary hemorrhage (in drug group) Excluding secondary hemorrhages, mean time to resolution of 7.1 days in drug group, (range 6 to 9); mean time to resolution of 4.0 days in placebo group, (range 3 to 4)
Blood filling ½ or more of anterior chamber 5/49 (10%) study participants; 2/24 (8.3%) in drug group; 3/25 (12%) in placebo group 1/3 (33%) secondary hemorrhage (in drug group) Excluding secondary hemorrhages, time to resolution of 10 days in drug group: mean of placebo = 4.3 (range 3 to 5)
Kutner 1987 Mean hyphema height 2.2 mm (SD 1.7, n = 21) in drug group; 1.7 mm (SD 1.0, n = 13) in placebo group “all who rebled had initial hyphemas of 15% or less” NR
McGetrick 1983; Mean hyphema height 100% (28/28) hyphemas in drug group were < 25% of anterior chamber; 86% (18/21) hyphemas in placebo group were < 25% of anterior chamber 1 secondary hemorrhage in drug group; 6 secondary hemorrhages in placebo group NR
Teboul 1995 Blood filling < ⅓ of anterior chamber 88/94 (94%) study participants; 44/48 (92%) in drug group; 44/46 (96%) in placebo group 1 secondary hemorrhages in drug group and 2 in placebo group NR
Blood filling ⅓ to ½ of anterior chamber 6/94 (6%) study participants; 4/48 (8%) in aminocaproic acid group; 2/46 (4%) in placebo group No rebleeds NR
Topical aminocaproic acid versus control
Karkhaneh 2003 Blood filling < ¼ of anterior chamber; excluded microscopic hyphemas 65/80 (81%) study participants; 34/41 (83%) in drug group; 31/39 (79.5%) in placebo group; Reported no effect of hyphema size on secondary hyphema (RR 0.7, 95% CI 0.2 to 2.5) NR
Blood filled ¼ to ½ of anterior chamber 14/80 (18%) study participants; 7/41 (17%) in drug group; 7/39 (18%) in placebo group
blood filling > ½ of anterior chamber; excluded total or blackball hyphemas 1/80 (1%) study participants; 0/41 in drug group; 1/39 (2.5%) in placebo group
Pieramici 2003 Mean hyphema height in mm 1 mm (SE 0) in drug group (range 0 to 4); 2 mm (SE 0) in placebo group (range 0 to 8) Size of primary hyphema in 2 participants with secondary hemorrhages in drug group: 0.3 and 1 mm; in 8 participants in the placebo group: 0.8, 0.9, 1, 1.4, 1.8, 2, 2, and 4.5 mm NR
Low versus standard dose of aminocaproic acid
Palmer 1986 Mean hyphema height in mm 1.7 mm (SD 2.0, range 0.1 to 9.9) in low dose group (n = 25); 1.5 mm (SD 2.2, range 0.1 to 9.9) in standard dose group 1.5 mm in standard dose group (n = 33) 1 secondary hemorrhage in low dose group; 5 secondary hemorrhages in standard dose group NR
Oral versus topical aminocaproic acid
Crouch 1997 Blood filling < ⅓ of anterior chamber 44/64 (69%) of study participants NR NR
Blood filling > ½ to ¾ of anterior chamber 6/64 (9%) of study participants
Blood filling > ½ to ¾ of anterior chamber 8/64 (13%) of study participants
Blood filling > ¾ to total of anterior chamber 6/64 (9%) of study participants
Tranexamic acid versus control
Rahmani 1999 Microscopic, but excluding patients with unlayered microscopic hyphemas 17/238 (7%) study participants; 6/80 (7%) in aminocaproic acid group; 4/78 (5%) in prednisolone group; 7/80 (9%) in placebo group 2/43 (5%) secondary hemorrhages NR
Blood filling < ¼ of anterior chamber 173/238 (72%) study participants; 56/80 (70%) in aminocaproic acid group; 61/78 (78%) in prednisolone group; 56/80 (70%) in placebo group 30/43 (70%) secondary hemorrhages
Blood filling ¼ to ½ of anterior chamber 36/238 (15%) study participants; 13/80 (16%) in aminocaproic acid group; 10/78 (13%) in prednisolone group; 13/80 (16%) in placebo group 7/43 (16%) secondary hemorrhages
Blood filling > ½ of anterior chamber; excluded total hyphemas 12/238 (5%) study participants; 5/80 (6%) in aminocaproic acid group; 3/78 (4%) in prednisolone group; 4/80 (5%) in placebo group 4/43 (9%) secondary hemorrhages
Sukumaran 1988 Hyphema height of 0 to 1 mm 8/35 ( 23%) study participants; 4/17 (24%) in drug group; 4/18 (22%) in control group NR NR
Hyphema height of 2 to 3 mm 12/35 (34%) study participants; 6/17 (35%) in drug group; 6/18 (33%) in control group
Hyphema height of 4 to 5 mm 10/35 (29%) study participants; 5/17 (29%) in drug group; 5/18 (28%) in control group
Hyphema height of 6 to 7 mm 5/35 (14%) study participants; 2/17 (12%) in drug group; 3/18 (17%) in control group
Vangsted 1983 Hyphema height of 1 mm 10/112 (9%) study participants; 8/59 (14%) in drug group; 2/53 (4%) in control group NR NR
Hyphema height of 2 mm 33/112 (29%) study participants; 15/59 (25%) in drug group; 18/53 (34%) in control group
Hyphema height of 3 mm 37/112 (33%) study participants; 18/59 (31%) in drug group; 19/53 (36%) in control group
Hyphema height of 4 mm 18/112 (16%) study participants; 9/59 (15%) in drug group; 9/53 (17%) in control group
Hyphema height of 5 mm 9/112 (8%) study participants; 6/59 (10%) in drug group; 3/53 (6%) in control group
Hyphema height of 6 mm 4/112 (4%) study participants; 3/59 (5%) in drug group; 1/53 (2%) in control group
Hyphema height of 7 mm None in either group
Hyphema height of 8 mm 1/112 (1%) study participants; 0/59 (0%) in drug group; 1/53 (2%) in control group
Varnek 1980 Mean hyphema height in mm 2.0 mm in drug group (n = 102); 2.1 mm in control group (n = 130) 1.0 mm in 2 study participants in drug group with a secondary hemorrhage; 2.2 mm in 12 study participants in control group with a secondary hemorrhage NR
Welsh 1983 Mean of proportion of anterior chamber area filled with blood 68% in drug group (n = 19); 63% in placebo group (n = 20) NR NR
Aminomethylbenzoic acid versus control
Liu 2002 Blood filling < ⅓ of anterior chamber and level is lower than the inferior boarder of pupil 47/92 (51%) study participants; 31/60 (52%) in drug group; 16/32 (50%) in control group NR NR
Blood filling ½ of anterior chamber and level is higher than the inferior border of the pupil, but not exceeding the median line 30/92 (33%) study participants; 19/60 (32%) in drug group; 11/32 (34%) in control group
blood filling > ½ of anterior chamber or filling the entire anterior chamber 15/92 (16%) study participants; 10/60 (17%) in drug group; 5/32 (16%) in control group
Oral corticosteroids versus control
Spoor 1980 0 to 33% of anterior chamber area filled with blood 38/43 (88%) study participants; 21/23 (91%) in prednisone group; 17/20 (85%) in placebo group 2/4 (50%) secondary hemorrhages

  1. 30 hyphemas resolved in 5 days or less; 8 hyphemas resolved in more than 5 days

  2. 34 patients with final visual acuity between 20/20 and 20/50
> 33% to 75% of anterior chamber filled with blood 5/43 (12%) study participants; 2/23 (9%) in prednisone group; 3/20 (15%) in placebo group 2/4 (50%) secondary hemorrhages

  1. 1 hyphema resolved in 5 days or less; 4 hyphemas resolved in more than 5 days

  2. 5 patients with final visual acuity between 20/20 and 20/50
Rahmani 1999 See above under “Tranexamic acid versus control”
Topical corticosteroids
Zetterstrom 1969 Mean hyphema height in mm 2.5 mm in topical corticosteroid group (n = 58); 3.5 mm in control group (n = 59) No patient with secondary hemorrhage in topical corticosteroid group; 4 patients with secondary hemorrhage in control group NR
Antifribrinolytics versus oral corticosteroids
Farber 1991 Microscopic 24/116 (21%) study participants; 11/56 (20%) in aminocaproic acid group; 13/56 (23%) in prednisone group, 3/8 (38%) secondary hemorrhages; 2 in aminocaproic acid group; 1 in prednisone group NR
Hyphema height of 0.1 to 3.9 mm 80/116 (69%) study participants; 41/56 (73%) in aminocaproic acid group; 39/56 (70%) in prednisone group 4/8 (50%) secondary hemorrhages; 1 in aminocaproic acid group; 3 in prednisone group
Hyphema height of 4.0 to 5.9 mm 4/116 (3%) study participants; 3/56 (6%) in aminocaproic acid group; 1/56 (2%) in prednisone group No secondary hemorrhages in either group
Hyphema height of 6.0 to 11 mm 2/116 (2%) study participants; 0/56 (0%) in aminocaproic acid group; 2/56 (4%) in prednisone group No secondary hemorrhages in either group
Total hyphema 2/116 (2%) study participants; 1/56 (2%) in aminocaproic acid group; 1/56 (2%) in prednisone group, 1/8 (12%) secondary hemorrhage; 1 in aminocaproic acid group; none in prednisone group
Rahmani 1999 See above under “Tranexamic acid versus control”
Conjugated estrogens versus control
Spaeth 1966 Blood filling < 20% of anterior chamber 55/85 (65%) study participants; 28/39 (72%) in estrogen treated group; 27/46 (59%) in control group 13/20 (65%) secondary hemorrhages; 8 in estrogen group; 5 in control group NR
Blood filling 20% to 40% of anterior chamber 17/85 (20%) study participants; 5/39 (13%) in estrogen treated group; 12/46 (26%) in control group 4/20 (20%) secondary hemorrhages; 1 in estrogen group; 3 in control group
Blood filling 40% to 60% of anterior chamber 5/85 (6%) study participants; 2/39 (5%) in estrogen treated group; 3/46 (7%) in control group 1/20 (5%) secondary hemorrhage; none in estrogen group; 1 in control group
Blood filling 60% to 80% of anterior chamber 2/85 (2%) study participants; 1/39 (3%) in estrogen treated group; 1/46 (2%) in control group no secondary hemorrhages in either group
Blood filling > 80% of anterior chamber 6/85 (7%) study participants; 3/39 (8%) in estrogen treated group; 3/46 (7%) in control group 2/20 (10%) secondary hemorrhages; 1 in estrogen group; 1 in control group
Cycloplegics versus miotics
Bedrossian 1974 Hyphema height of 1 mm 20/58 (34%) study participants; 10/28 (36%) in the cycloplegic group; 10/30 (33%) in the miotic group 1/1 (100%) secondary hemorrhage (in cycloplegic group) Mean time to resolution in cycloplegic group of 1.9 days (SD = 1.4); mean time to resolution in miotic group of 2.5 days (SD= 1)
Hyphema height of 2 mm 22/58 (38%) study participants; 10/28 (36%) in the cycloplegic group; 12/30 (40%) in the miotic group No secondary hemorrhages in either group Mean time to resolution in cycloplegic group of 3.3 days (SD = 1.8); mean time to resolution in miotic group of 4.2 days (SD = 1.3)
Hyphema height of 3 mm 12/58 (21%) study participants; 6/28 (21%) in the cycloplegic group; 6/30 (20%) in the miotic group No secondary hemorrhages in either group Mean time to resolution in cycloplegic group of 3.2 days (SD = 1.9); mean time to resolution in miotic group of 4.0 days (SD = 1.1)
Hyphema height of 4 mm 4/58 (7%) study participants; 2/28 (7%) in the cycloplegic group; 2/30 (7%) in the miotic group No secondary hemorrhages in either group Mean time to resolution in cycloplegic group of 2.5 days (1 resolved on day 2 and 1 on day 3); mean time to resolution in miotic group of 4.0 days (1 resolved on day 3 and 1 on day 5)
Aspirin versus no aspirin
Marcus 1988 Reported that “the two groups were comparable with respect to age, cause, and extent of hyphema” and that 2 of 3 eyes with a secondary hemorrhage in the aspirin group (n = 23) had an initial total hyphema, while of the 2 eyes with a secondary hemorrhage in the control group (n = 28), 1 had 30% and 1 had almost total hyphema NR
Monocular versus binocular patching
Edwards 1973 Blood filling < ⅓ of anterior chamber 42/64 (66%) study participants; 21/35 (60%) in the monocular patching group; 21/29 (72%) in the binocular patching group 7/14 (50%) secondary hemorrhages; 4 in the monocularly treated group; 3 in the binocularly treated group 62% (13/21) of patients with final visual acuity of 20/50 or better in the monocularly treated group; 71% (15/21) of patients with final visual acuity of 20/50 or better in the binocularly treated group
Blood filling ⅓ to ½ of anterior chamber 14/64 (22%) study participants; 9/35 (26%) in the monocular patching group; 5/29 (17%) in the binocular patching group 7/14 (50%) secondary hemorrhages; 4 in the monocularly treated group; 3 in the binocularly treated group 57% (8/14) of patients with final visual acuity of 20/50 or better in the monocularly treated group; 62% (5/8) of patients with final visual acuity of 20/50 or better in the binocularly treated group
Blood filling ½ or more of anterior chamber 8/64 (12%) study participants; 5/35 (14%) in the monocular patching group; 3/29 (11%) in the binocular patching group
Ambulatory versus conservative treatment
Read 1974 Blood filling < ⅓ of anterior chamber 79/137 (58%) study participants; 47/71 (66%) in the ambulatory group; 32/66 (48%) in the conservatively treated group 16/30 (53%) secondary hemorrhages; 9 in the ambulatory group; 7 in the conservatively treated group NR
Blood filling ⅓ to ½ of anterior chamber 11/71 (16%) patients in the ambulatory group; 17/66 (26%) or patients in the conservatively treated group 5/30 (17%) secondary hemorrhages; 4 in the ambulatory group; 1 in the conservatively treated group
Blood filling ½ but not total anterior chamber 8/71 (11%) patients in the ambulatory group; 11/66 (17%) or patients in the conservatively treated group 6/30 (20%) secondary hemorrhages; 3 in the ambulatory group; 3 in the conservatively treated group
Total hyphema 5/71 (7%) patients in the ambulatory group; 6/66 (9%) or patients in the conservatively treated group 3/30 (10%) secondary hemorrhages; 2 in the ambulatory group; 1 in the conservatively treated group
Elevation of head versus lying flat
Zi 1999 Blood filling < ½ of anterior chamber and level is lower than the inferior boarder of pupil 36/74 (49%) study participants; 18/35 (51%) with elevation of the head; 18/39 (46%) lying flat NR NR
Blood filling ½ of anterior chamber and level is higher than the inferior border of the pupil 19/74 (26%) study participants; 6/35 (17%) with elevation of the head; 13/39 (33%) lying flat NR NR
Blood filling > ½ of anterior chamber or filling the entire anterior chamber 19/74 (26%) study participants; 11/35 (31%) with elevation of the head; 8/39 (21%) lying flat NR NR
Other
Rakusin 1972 * Blood filling < ½ of anterior chamber n = 213 NR

  1. 4% (8/213) of patients with elevated intraocular pressure across all patients

  2. 22% (47/213) of patients with complications

  3. 78% (166/213) of patients with final visual acuity better than 20/60
Blood filling > ½ of anterior chamber n = 157 NR

  1. 85% (133/157) of patients with elevated intraocular pressure across all patients

  2. 78% (123/157) of patients with complications

  3. 28% (44/157) of patients with final visual acuity better than 20/60
*

Rakusin 1972 reported severity for entire study population rather than by trials of topical corticosteroids, cycloplegics versus miotics, monocular versus binocular patching, and ambulatory versus conservative treatment. See under “Other”

95% CI: 95% confidence interval

mm: millimeter

n: number of participants

NR: not reported

RR: relative risk

SD: standard deviation

SE: standard error