How is uncontrolled intraocular pressure treated 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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If intraocular pressure is still uncontrolled, systemic medication should be given during the acute phase of the hyphema. Acetazolamide (20 mg/kg/d) may be administered in 4 divided doses for intraocular pressure of greater than 22 mm Hg. However, acetazolamide can increase the concentration of anterior chamber ascorbate, lower the pH of human plasma, and exacerbate sickling of erythrocytes. Therefore, methazolamide (10 mg/kg/d), administered in 4 divided doses, is preferred in pediatric patients with sickle cell trait or sickle cell disease. [6, 28]

Osmotic agents (preferably mannitol) should be considered for intraocular pressure above 35 mm Hg despite topical medications. Orally administered glycerol is effective; however, nausea and vomiting are often associated with its administration in patients with elevated intraocular pressure. Mannitol is administered intravenously, 1.5 g/kg (usually in a 10% solution), over a period of approximately 45 minutes. This agent may be given 2 times a day (or every 8 hours in patients with extremely high pressure) in attempt to keep the intraocular pressure below 35 mm Hg. Renal output, blood urea nitrogen, and electrolyte values should be monitored in all patients in whom such therapy is continued for several days.

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