Hyphäma (NEJM 2015)

Beate J. Langner-Wegscheider, M.D., and Robert Krause, M.D.
N Engl J Med 2015; 372:1549

A 33-year-old man who was a pig farmer presented with sudden blurred vision, pain, redness, and photophobia in both eyes. He had a 10-day history of persistent fever (temperature, 39.4 C°), malaise, and myalgia. Ophthalmologic examination revealed bilateral iridocyclitis (anterior uveitis). Local treatment (prednisolone eyedrops and ointment and cyclopentolate eyedrops) alleviated the pain and photophobia overnight, but the next morning he had hyphema in his left eye (Panel A shows a view with the light-source reflection at the 3 o’clock position, and Panel B at the 9 o’clock position illuminating a section of the anterior chamber). Laboratory testing revealed a γ-glutamyltransferase level of 129 U per liter (normal value, <55), an alanine aminotransferase level of 49 U per liter (normal value, <45), and a white-cell count of 11,700 per cubic millimeter (normal range, 4400 to 11,300). Clinical and laboratory findings suggested a diagnosis of leptospirosis. Serologic tests revealed IgM and IgG antibodies against Leptospira interrogans serovar serjoe. Hyphema is usually caused by ocular trauma, but in rare cases, it can be a result of infection. With continued local treatment and the addition of systemic treatment with amoxicillin, the patient’s symptoms abated and his laboratory values and vision returned to normal within 2 weeks. The hyphema and eye redness resolved completely 1 month after their appearance.
HyphamHyphaema (von griechisch ὑπό hypo (unter) und αἷμα haima (Blut)) ist in der Augenheilkunde eine Blutansammlung in der vorderen Augenkammer. Sie kann Folge einer Verletzung, akuter hämorrhagischen Iritis oder Infektion sein. Bei aufrechter Kopfhaltung zeigt sich die Blutansammlung beim Hyphaema als horizontaler Spiegel