What are the risk factors for corneal bloodstaining in patients with hyphema?

Updated: Jan 18, 2019
  • Author: David L Nash, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Corneal bloodstaining primarily occurs in patients with a total hyphema and associated elevation of intraocular pressure. The following factors may increase the likelihood of corneal bloodstaining; all of these factors affect endothelial integrity:

  • Initial state of the corneal endothelium; decreased viability resulting from trauma or advanced age (eg, cornea guttata)

  • Surgical trauma to the endothelium

  • Large amount of formed clot in contact with the endothelium

  • Prolonged elevation of intraocular pressure

Corneal bloodstaining may occur with low or normal intraocular pressure; rarely, it may also occur in less than total hyphemas. However, these two instances can probably be anticipated only in eyes with a severely damaged or compromised endothelium. Corneal bloodstaining is more likely to occur in patients who have a total hyphema that remains for at least 6 days with concomitant, continuous intraocular pressures of greater than 25 mm Hg. [6] Clearing of the corneal bloodstaining may require several or many months. Generally, the corneal bloodstains form centrally and then spread to the periphery of the corneal endothelium. During resolution, corneal bloodstaining reverses the sequence of the initial staining process, clearings peripherally and then centrally.

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