ABSTRACT
This chapter addresses the assessment and surgical management of traumatic hyphema, iridodialysis, and corneoscleral lacerations. Traumatic hyphema occurs most commonly after blunt trauma; however, a third of cases are due to a penetrating or perforating eye injury. Visual acuity and particularly a pupillary examination may alert the examining physician to more extensive pathology, such as suprachoroidal hemorrhage, occult scleral rupture, or traumatic optic neuropathy. In cases of significant angle damage or total hyphema with elevated intraocular pressure, trabeculectomy and peripheral iridectomy in conjunction with anterior chamber washout have been advocated. A standard trabeculectomy and peripheral iridectomy are fashioned at the superior limbus. When a laceration extends to the limbus or subconjunctival hemorrhage prevents a complete examination, a limbal peritomy and careful inspection of that area are recommended. Large extracapsular wounds should be avoided in acutely traumatized eyes, because there may be increased risk of expulsive choroidal hemorrhage.
