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Departmental Papers (Vet) School of Veterinary Medicine

1-1-2000

Hyphema. Part II. Diagnosis and Treatment

Andrs M. Komromy

David T. Ramsey

Dennis E. Brooks

Cynthia C. Ramsey

Maria E. Kallberg
See next page for additional authors

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Recommended Citation
Komromy, A. M., Ramsey, D. T., Brooks, D. E., Ramsey, C. C., Kallberg, M. E., & Andrew, S. E. (2000). Hyphema. Part II. Diagnosis
and Treatment. Compendium on Continuing Education for the Practicing Veterinarian, 22 (1), 74-79, 96-. Retrieved from
http://repository.upenn.edu/vet_papers/52

Dr. Komromy was affiliated with the University of Pennsylvania from 2003-2012.
Part I can be found at http://repository.upenn.edu/vet_papers/51/

This paper is posted at ScholarlyCommons. http://repository.upenn.edu/vet_papers/52

For more information, please contact libraryrepository@pobox.upenn.edu.
Hyphema. Part II. Diagnosis and Treatment
Abstract
The clinical appearance of hyphema is variable and is influenced by the volume of blood and the amount of
time erythrocytes are present in the anterior chamber. When hyphema is evident, a complete history should
be obtained and a thorough physical examination performed to direct the initial selection of diagnostic tests.
Secondary complications of hyphema include glaucoma, synechiae, cataract formation, blood-staining of the
cornea, and blindness. Frequent measurement of intraocular pressure is recommended. The two primary
management issues in animals with hyphema are prevention of secondary hemorrhage (by treating the
underlying disease) and control of secondary glaucoma.

Disciplines
Eye Diseases | Medicine and Health Sciences | Ophthalmology | Veterinary Medicine

Comments
Dr. Komromy was affiliated with the University of Pennsylvania from 2003-2012.

Part I can be found at http://repository.upenn.edu/vet_papers/51/

Author(s)
Andrs M. Komromy, David T. Ramsey, Dennis E. Brooks, Cynthia C. Ramsey, Maria E. Kallberg, and Stacy
E. Andrew

This journal article is available at ScholarlyCommons: http://repository.upenn.edu/vet_papers/52

 Vol. 22, No.1 January 2000

reclll
ofa
Article #4 (1.5 contact hours) ic di :
CE
Refereed Peer Review TI
is PI [
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diffe
Hyphema. Part II. exan
coag

Diagnosis and Treatment* take

whe l
FOCAL POINT med
lar tJ
Un iversiry of Florida Mi chi ga n Stare 0niversiry also
Hyphema is frequently associated
with iridocyclitis and generally Andras M. Komaromy, Dr.med.vet. David T. Ramsey, DVM pher
implies severe intraocular or
Dennis E. Brooks, DVM, PhD Cynthia C. Ramsey, DVM, MS PH~
systemic disease.
Maria E. Kallberg, DVM TI
an aJ
KEY FACTS Stacy E. Andrew, DVM
not I
ed e
The prognosis for animals with ABSTRACT: The clinical appearance of hyphemais variable and is influenced by the volume of e1im
hyphema depends in large part blood and the amount of time erythrocytes are present in the anterior chamber. When hyphe pruc
on the identification of underlying ma is evident, a complete history should be obtained and a thorough physical examination that
diseases; institution of proper performed to direct the initial selection of diagnostic tests. Secondary complications of hyphe ocul
treatment; and careful , long-term ma include glaucoma, synechiae, cataract formation , blood-staining of the cornea, and blind 109 :
follow-up, p. 74. ness. Frequent measurement of intraocular pressure is recommended. The two primary man unn ,
agement issues in animals with hyphema are prevention of secondary hemorrhage (by
ougr
treating the underlying di.sease) and control of secondary glaucoma.
A thorough ophthalmic and amll
systemic diagnostic evaluation tect
should be performed when art I of this two-part presentation reviewed the pathophysiologic mecha syste
hyphema is present, p. 75.

The two primary management

P nisms that most frequently result in hyphema in animals; this article cov
ers diagnostic and treatment considerations. The prognosis for animals
with hyphema depends on identifYing the underlying cause; initiating prope r
orrh
bran
muo
issues in animals with hyphema treatment; and careful, long-term follow-up. sa) (
are preventing secondary sent
hemorrhage (i.e., rebleeding) HISTORY tope
and controlling secondary When hyphema is evident, a complete history should be obtained and a thor~ Intrd
glaucoma, 77. ough physica.l examination performed to direct the ,i nitial selection of appropriate IrIS I

Frequent measurement of
intraocular pressure is required
in patients with hyphema, p. 78.
diagnostic tests. Recent health and vaccination statlls should also be ascertained. hyp l
Trauma or ingestion of toxins (e.g., anticoagulant todenticide) should be consid Abd,
ered if an animal has access to the outdoors regardless of whether a traumatic in tion
cident or rodenticide ingestion was witnessed by the owner. Living in or travel to veal
regiom in which enzootic infectious disease (e.g., ehrlichiosis, Rocky Mountain a th :
spotted fever) is common should alert clinicians to consider infectious agents as a rhag
potential cause of hyphema. Recent drug administration or past illness may be men'
important factors in determining the cause of hyphema. A recent history of ab tivel)
normal vision or behavior before the onset of hyp hema may signifY preexisting or intr.
underlying ocular (e .g., iridocyclitis , glaucoma, retinal detachment) or central shou
nervous system (e.g., hemorrhage, retrobu1bar optic neuriris) disease. Hisrory of iden!

*Parr I of this [Wo-parr presentation appeared in the November 1999 (Vol. 21 >No . 11 ) OPH
issue of Compendium. Tf:
 Compendium January 2000 Small Animal/Exotics 75

recurrent hyphema is suggestive detailed ophthalmic examina

of a persistent ocular or system tion of both the anterior and
ic disease. posterior segments of the af
The time at which hyphema fected and contralateral eye. In
is first observed may also assist direct pupillary light response
clinicians in developing a list of allows the evaluation of retinal
I differential considerations. For function, even with a blood
example, hyphema from anti filled anterior chamber, as long
coagulant rodenticide toxicity as the contralateral pupil is vis
takes 5 to 7 days to develop, ible. Iridocyclitis manifests as
whereas hemorrhage occurs im conjunctivitis, corneal edema,
mediately in patients with ocu miosis, and hyporony. Glauco
lar trauma. Ocular neoplasia may Figure 1A ma and retinal detachment are
also cause an acute onset of hy generally associated with a my
phema. driatic pupil. When hyphema
2
is aruibutable to a systemic dis
PHYSICAL EXAMINATION 3
ease process, the contralateral
The physical examination of eye may also have clinical sigll:s
an animal with hyphema should suggestive of the disease. Fun
not be limited only ro the affect 1 duscopic examination allows
ed eye. \Vhen trauma has been direct visualization of delicate
eliminated as a likely cause, the vascular structures (retinal and
prudent approach is ro assume choroidal vasculature) and cen
that a serious sight-threatening tral nervous tissue (optic nerve
ocular disease or life-rhreaten head, retina). Ocular signs sug
ing systemic disease is present gestive of systemic vasculitis are
until proven otherwise. A thor- Figure 1B frequently detected during ex
ough and detailed physical ex Figure 1-Photograph (A) and photomicrograph (B) amination of the fundus.
amination is indicated to de showing inrrastromal hemorrhage of rhe iris (1) in a Depending on the cause and
tect any underlying evidence of dog (cornea (2J, anterior chamber (3J, posrerior cham severity of blood-ocular barrier
systemic disease. Petechial hem ber (4j). (Hematoxylin & eosin srain; original magni breakdown and the presence of
orrhages of the mucous mem ficarion, x40) iridocyclitis, aqueous flare (pre
branes (i.e., conjunctiva, oral dominantly proteins), hypopy
mucosa, preputial/vulvar m uco on, or hyphema may appear in
sa) or skin are frequently pre the anterior chamber. The clin
sent along with thrombocy ical appearance of hyphema is
topenia or thrombocytopathy. influenced by the volume of
Intrastromal hemorrhage of the erythrocytes in the anterior
iris may also be present before chamber and by how long they
hyphema occurs (Figure 1). have been present and may dif
Abdominal and thoracic palpa fer substantially from case to
tion and auscultation may re case. The term complete or to
veal physical signs suggestive of tal h),phema is used to describe
a third-compartment hemor- hemorrhage filling the entire
rhage or vital organ involve- Figure 2-Complere (toral) hyphema in a dog. anterior chamber and is usually
memo Unless trauma is defmi- a result of acute fulminant or
tively identified as the cause of recurrent hemorrhage (Figure 2).
intraocular hemorrhage, every cat with hyphema Complete hyphema obstructs the examiner's ability to
should have its arterial blood pressure measured to visualize intraocular structures.
identify systemic hyperrension. 1 The blood in a complete hyphema may change color
from red to black as a result of altered aqueous dynam
OPHTHALMIC EXAMINATION ics, indicating the cessation of aqueous circulation. 2 If
The physical examination should always include a hemorrhage was initially minimal and transitory, hy-

IRIDOCYC LlTI S FUNDUSCOPIC EXAMINATION . COMPLETE HYPHEMA

76 Small Animal/Exotics
phema is light red in appear
ance. This type of hyphema may
develop a shallow line of demar
cation (i.e. , gravity line) when
erythrocytes settle due to gravity
in a homogeneous layer in the
ventral anterior chamber (Figure
3). Extensive or persistent hem
orrhageinto the anterior cham
ber appears bright red in color
and may occlude both the pupil
and iris. Complete hyphema at
tributable to transient hemor
rhage that has been present for
at least 5 to 7 days appears dark
red or bluish-black and is re
ferred to as eight-baff hyphema Figure 3-Hyphema wirh gravity line. Eryrhrocytes be performed if suggested by ge
(Figure 4) ..1 Decreased oxygena sertle due (0 gravity in a homogeneous layer in rhe ographic location, travel history,
tion of erythrocytes in the ante ventral anterior chamber.
rior chamber is reflected by the
dark color. 2 Chronic active hy
phema may appear light or dark
red or bluish-black, depending
on when the last active hemor
rhage occurred. Occlusion of the
pupil by hyphema may cause a
relative pupillary block that in
hibits aqueous circulation to the
anterior chamber, resulting in
subsequent elevated intraocular
pressure (lOP).
There are definitive circum Figure 4-Dark red or bluish-black appearance of essarily correlate with clinical
stances thac determine when eighr-ball hyphema.
blood in the anterior chamber --------------------------------------- rive agents. ' When a systemic
mayor may not clot. Hyphema
caused by trauma, vasculitis (e.g., feline infectious peri
tonitis [FIP]), or iridocycliris may clot, whereas hyphe
rna attributable to immune-mediated thrombocytope
nia or warfarin toxicity generally will not dot. '!
Hyphema attributable to rubeosis iridis (new vascular
proliferation of the iris), intraocular neoplasia, or con
genital ocular anomalies may occasionally clot. "
EXPANDED DATABASE
Laboratory tests should be performed based on find
ings from the history and physical examination. A di
rect blood smear permits rapid estimation of platelet
and megathrombocyte numbers and the detection of
erythrocyte and leukocyte involvement (e.g., presence
of schistocyrosis or Haemobartonella). Platelets, leuko
cytes, and erythrocytes should be evaluated by a com
plete blood count (CBC); the three cell lines may be af
fected individually (e.g., thrombocytopenia) or con-
EIGHT-BALL HYPHEMA INFECTIOUS DISEASES
Compendium January 2000
currently (e.g., bone-marrow dis TREA
ease). If bone-marrow disease is Prir
suspected based on CBC results, ma 111
aspiration cytology with or with bleed i
out core biopsy is indicated. 4 treati l
Serum biochemical profile and glauc<
urinalysis may help identify such amon l
underlying abnormalities as liver from I
disease, renal insufficiency, or hy
peradrenocorticism.
Indications for selecting more
specific diagnostic tests are de
termined by history, physical ex-
3.mination findings, and initial Irido
diagnostic test results. Evalua
tion for infectious diseases should
or exposure to other risk factors.
Toxoplasma gondii, feline leukemia
virus (FeLV), feline immuno
deficiency virus (FIV), and FIP
infection and possibly systemic
fungal diseases should be consid
ered when hyphema is evident ,in
a cat. 5 The seroprevalence of T
gondii in cats with iridocyclitis
was reported to be as high as
78.5%. 5 However, serologic evi
dence of infection by T gondii,
FeLV, FIV, or FIP does not nec
disease induced by these causa
Bloo(
bleeding disorder is suspected, a
coagulat,i on profile should be completed. 4 Secor
Sampling of aqueous humor to determine local in
traocular antibody production is not ,i ndicated in pa
tients with hyphema because the sample will be con
taminated with systemic blood. When hyphema
prevents visualization of intraocular structures,
transcorneal B-mode ultrasound (7.5- to 12-MHz
transducer) is indicated to determine whether retinal
detachment or intraocular tumors are present or to
identify other oCLIlar lesions (e.g., luxated lens, intraoc
ular foreign body).G Skull radiographs, computed to
mography, or magnetic resonance imaging may also re
veal an intraocular foreign body, depending on the
type or composite. When a metallic intraocular foreign
body is suspected, magnetic resonance imaging should
See rl
be avoided and computed tomography performed.
bUnd
Retinal function can be evaluated using electroretinog
raphy. 7
lV= il
IMAGING TECHNIQUES
Compendium January 2000 Small Animal/Exotics 77

TREATMENT rna treatment is management of the iridocyclitis that is

Primary management issues in animals with hyphe
rna include preventing secondary hemorrhage (i.e., re
bleeding) by (1) treating the underlying disease, (2)
treating iridocyclitis, and (3) controlling secondary
glaucoma (Table I). There is considerable variation
among specific treatment regimens to eliminate blood
from the anterior chamber, bur the hallmark of hyphe
frequently present. Erythrocytes exit the anterior cham
ber primarily through the iridocorneal dra,i nage angle.
The iris produces enough fibrinolytic enzymes in most
instances to prevent blood from cloning so that it can
more easily exit the anterior chamber via the aqueous
humor outflow pathways. Uncomplicated hyphema
should resolve within 7 to 21 days. 3 Hyphema that

TABLE I

Treatment of Hyphema".I J

Disorder Drug Class Drug Frequency/Dose

Iridocyclitis)' Topical parasympatholytics Atropine 1% (use ointment
1-4 times daily
in cats)

Topical corticosteroids Prednisolone acetate suspension

4-6 times daily
1%, dexamethasone solution 0.1 %

Dexamethasone ointment 0.05% 3-4 times daily

Topical NSAIDs Flurbiprofen 0.03%, suprofen 1%, 4 times daily
indomethacin 1%, diclofenac 0.1 %
y temic corticosteroids Prednisone 1-2 mg/kg/day in
divided doses
Systemic NSAIDs Aspirin Dogs: 10-15 mg/kg PO
2-3 times daily
Cats: 80 mg PO every
48-72 hr
Flunixin meglumine Dogs: 0.25-0.5 mg/kg
IV, single dose
Carprofen Dogs: 2 mg/kg PO
t\vice daily

Blood or fibrin clot \9 Fibrinolytics Tissue plasminogen activator 25-75 flg intracamerally

Secondary glaucoma ' O. 11 Systemic carbonic Dichlorphenamide Dogs: 2-4 mg/ kg PO

anhydrase inhibitors 2-3 times daily
Cats: 1 mg/kg PO 2-3
times daily
Methazolamide 2-4 mg/kg PO 2-3
times daily
Topical carbonic Do rzolamide 3% 3 times daily
anhydrase inhibitors
Topical sympathomimetic Epinephrine 1%, 2-3 times daily
drugs di pivefrin HCI 0.1 %
Topical sympatholytic T imolol maleate 0. 5% 2-3 times daily
drugs
Osmotic agents Mannitol 0.5-1.0 g/kg IV
"See rexr for derails.
"Underlying diseases should be rreared firsr in cases ofhyphema.
IV = inrravenously; PO = orally.
78 Small Animal/Exotics
continues to bleed may indicate that the underlying
disease is still present. Surgical removal of a blood clot
with or without iridectomy is discussed in the human
medicalliterature 2 12 and is rarely necessary in human or
veterinary patients.
Prevention of a posterior synechiae and iris bombe is
achieved with the use of topical parasympatholytics
(e.g., atropine) to dilate the pupil and topical cortico
steroids to suppress anrerior uveitis (Table I). In addi
tion to prevenring synechiae, topical atropine (a topical
mydriatic and cycloplegic drug) also relieves some pain
associated with spasm of the ciliary musculature and
helps to stabilize the blood-aqueous barrier. I.I- 1> If an
increase in lOP is noted after the initiation of mydriat
ic treatment, atropine should be discontinued immedi
ately and glaucoma treatment initiated.'
Topical use of parasympathomimetic drugs (e.g., pi
locarpine) to treat hyphema has been advocated to con
tract the ciliary musde, which hypothetically facilitates
drainage of blood from the anrerior chamber through
the iridocorneal angle. I !; Parasympathomimetic drugs
also cause miosis, which increases iris surface area,
thereby hypothetically exposing iris surface fibri
nolysins to the clot and blood in the anrerior cham
ber. 1(. We do not recommend using topical parasympa
thomimetic drugs to treat hyphema; they dilate iris
blood vessels and increase iridal intravascular pressure,
which may exacerbate hyphema. Because these drugs
induce miosis, the risk of posterior synechiae forma
tion, iris bombe, and peripheral anrerior synechiae for
mation is increased.
Nonspecific reduction of ocular inflammation to pre
serve the transparency and function of ocular structures
and stabilize the blood-aqueous barrier can be achieved
with topical corticosteroids andlor NSAIDs (Table
I). Ll.1 7 Topical corticosteroids are contraindicated when
corneal ulceration is present. Systemic administration
of NSAIDs can further decrease inflammation but
should also be used very cautiously because of their in
terference with platelet function. Systemic cortico
steroids (e.g., prednisone, prednisolone) should be used
cautiously and only when systemic infectious disease
has been ruled out or is being treated concurrently. Sys
temic immunosuppressive doses of corticosteroids and
systemic carbonic anhydrase inhibitors may help to
reattach retinas in patients wi th exudative detach
ments. IH.l~
Although the use of anrifibrinolytic agents in the
managemenr of hyphema is conrroversial, intracameral
injection of tissue plasminogen activator (tPA) to in
duce fibrinolysis can be performed to reverse a pupil
lary block when the iris is adhered to the lens by a
blood or fibrin clot (Table I) ..1.~. 12 tPA is most effective
PARASYMPATHOMIMETIC DRUGS TISSUE PLASMINOGEN ACTIVATOR .
Compendium January 2000
when injected within 48 hours of clot formation, but it clea
can also be effective tn dissolving clots of longer dura If tl
tion. ' However, tPA injections may also induce hyphe 101
rna or result in more severe hyphema from dissolution oft
of a blood clot when given within 24 hours of the ini onc
tial hemorrhage or when recurrent bleeding is Iikely..1 9 Intr
Surgical intervention and concurrent systemic and er h
topical treatment with antibiotics should be considered
when hyphema results from penetrating ocular injury
or blunt trauma with eyeball rupture. Restricted exer 1.
cise or even cage rest is recommended to prevent re
2.
bleeding. Animals with hyphema may need to be hos
pitalized for close monitoring of possible secondary
hemorrhages and elevation of rOp. lOP should be mea
sured at least daily during the hospital stay a'nd fre 3.
quently after discharge. 12 ,IG We do not recommend
Schiotz tonometry in animals with weakened corneas
caused by penetrating trauma. 4.
If secondary glaucoma develops due to anterior or
posterior synechiae of the iris , treatment can be at 5.
tempted (e.g., intracameral tPA and antiglaucoma
drugs) but the prognosis to save vision is poor. When
6.
the eyeball is irreversibly blind or painful from sec
ondary glaucoma, enucleation should be performed. 7.
Medical treatment of secondary glaucoma consists of a
combination of systemic or topical carbonic anhydrase
inhibitors, topical sympathomimetic drugs, and sympa
8.
tholytic drugs (Table I). Osmotic agents are less effec
tive with a leaky blood-ocular barrier. Because of the
risk of posterior synechiae, parasympathomimetic drugs 9,
(e.g., pilocarpine) are contraindicated.
10.
COMPLICATIONS
Mild hyphema may resolve without significant se
quelae. The main complications of persistent hyphema I 1. I
are increased lOP, peripheral anterior and posterior
synechiae, development of cataracts, and an increased
12. I
risk of corneal bll ood staining attributable to endothe
lial damage and breaks in Descemet's membrane. 12 If an \3,
underlying disease persists and hemorrhage is recurrent,
atrophy of the eyeball (phthisis bulbi) and blindness are
usually the long-term results. 14,
PROGNOSIS
Prognosis for vision in geriatric dogs with hyphema 15 . 1
secondary to retinal disease is grave, 20 In cases of unex
plained, unresponsive, or recurring hyphema, the diag
nosis must be reassessed. Prognosis is grave for any hy 16, 1
phema in which an unknown underlying systemic
17. \
disease persists. In such cases, enucleation is recom
mended if the lOP rises to leve'ls that cause pain. When
intraocular neoplasia is known or strongly suspected as
the cause for hyphema, the affected eye should be enu 18.
SURGICAL INTERVENTION
cleared and submiued for histopathologic evaluation. l
If the underlying cause is nonrec urring or treated and
lOP does nor increase, an accurate prognosis for return
of the eye to cosm e tic and visual normalcy can be made
once resorption of the h emorrhage allows a complete
intraocular examination ..' It is difficult to predict wheth 20 . Nelms SR, Nasisse MP, D avidso n MG, Kirschner SE: H y
er hyphema will resorb.
REFERENCES
I. Henik RA: Sysremic hyperrension and irs managemem. Vet
C!in North Alii SmaIL Anim Pract27 (6): 1355- 1372, 1997.
2. Fo lberg R, Parrish RK: G lauco ma following trau ma , in Tas
man W , Jaeger EA (cds) : Duane's Ophthalmology, Clil1iCtlI
Volume 3, CD-ROM Edition. Hagersrown, MD, Lippincon
Raven, 1998.
3. Collins BK, Moore CP: Diseases and surgery of rhe ca nin e
amerior uvea, in Gelan KN (cd): Veteril1fl1)' Ophthalmology,
ed 3. Baltimore, Lippincorr Williams & Wilkins, 199 9, pp
75 5-795.
4. H ack ne r SG: Approach ro rhe diagnosis of bleeding disor
ders. Compend Contin Educ Pract Vet 17(3):33 1-34 9, 199 5.
5. C havkin MJ, Lappin MR , Powell Cc, er al: Se roep idemio
logic and clinical observarions of 93 cases of uveiris in cars.
Prog Vet Comp OphthalmoI2(l):29-36, 1992.
6. Williams J, Wilkie DA: Ulrrasonography of rhe eye. Com
pend Contin Educ Pract Vet 18(6) :667-676, 1996.
7. Komaromy AM , Smirh PJ, Brooks DE: Elecrrorerinography
in dogs and cars. Parr If. Technique, imerprerari on, and in
dicarions. Compend Contin Ec!lIe Pract Vet 20(3):355-366,
1998.
8. Wilkie DA: Uvea, in Bi rcha rd SJ, Sherding RG (eds): Saun
ders ManuaL of SmaLl Animal Practice. Phil adelphia , WB
Saunders Co, 1994, pp 1213-1216.
<). Marrin C, Kaswan R, Grarzek A, er al: Ocular use of ri ss ue
plasminogen acrivaror in companion animals. Prog Vet Comp
OphthalmoI3(l):29-36,1993.
10. Wilkie DA: G lau co ma, in Birchard SJ, Sherding RG (eds):
Saunders ManuaL ofSma!! Animal Practice. Philadelphia, WB
Saunders Co, 1994, pp 121 7-1222.
1 I. Gelan KN , Brooks DE: The canine glaucomas, in Gelarr
KN (ed): Veterinary Ophrhalmology, ed 3. Balrimore, Lippin
co rr Williams & Wilkins, 199 9, pp 70 1-754.
12. GortSch JD: H yphema: Diagnosis and managemenr. Retina
10(S uppl 1):S65-S7 1, 1990.
13. Bisrner S: Allergic- an d immunologic-medi ared diseases of
rhe eye and adncxae. Vet Clin North Am Small Anim Pract
24(4): 7 ll-734, 1994.
14. Swan KC, Har r WM: A compararive srudy of rhe effecrs of
mec holyl, doryl , eserine, pilocarpin e, arropine , and epineph
rin e on rhe blood-aqucous bar rier. A m j Ophtha/mol 23( 12):
l311-1319 , 1940.
15. Van Alphen GWHM , Macri FJ: Enrrance of fluorescein inro
aqueous humor of cat eye. Arch OphthaLmoI75(2):247-253,
1<)66.
16. W im ton SM: Ocular em ergencies. Ver CLin North Am Small
A nim P/'tlct 11(1) :59-76, 1981.
17. Ward DA, Ferguson DC, Ward SL, er al: Com parison of rhe
blood-aqueous barrier stabilizin g effec rs of sreroidal and non
sreroidal a nti-inflammatory agenrs in rh e dog. Prog Vet
Comp OplnhaLmoI2 (3): 11 7-124, 1992.
18. Ki m M , Marmor MF: Reri nal adJles ive force in living rabbir,
car, and monkey eyes. Normarive dara and enhancemenr by
manni ro l and ace ra zo lamide . Invest Ophthalmol Vi,. Sc i
33(6): 1879- 1882, 1992.
19. Andrew SE, Abrams KL, Brooks D E, Kuhili s PS: Clinical
features of sreroid respo nsi ve rerinal d erachmenrs in twenry
rwo dogs. Prog Vet Comp OphrhaLmoI7(2):82-87 , 1997.
phem a associared wi rh rer inal disease in dogs: 17 cases
(1 986-19 9 1), jAVMA 202(8) : 1289-1 292, 1993.
About the Authors
Drs. Komaromy, Brooks, Kallberg, and Andrew are affili
ated with the Department of Small Animal Clinical Sci
ences, College of Veterinary Medicine, University of Flori
da, Gainesville, Florida. Drs. David and Cynthia Ramsey
are affiliated with the Department of Small Animal Clinical
Sciences, College of Veterinary Medicine, Michigan State
University, East Lansing , Michigan. Drs. David Ramsey,
Brooks, and Andrew are Diplomates of the American Col
lege of Veterinary Ophthalmologists. Dr. Cynthia Ramsey
is a Diplomate of the American College of Veterinary In
ternal Medicine and thwAmerican College of Veterinary
Emergency Medicine and Critical Care.
ARTICLE #4 CE TEST
The article you have read qualifies for 1.5 con
tac t hours of C ontinuing Education Credit from
the Auburn Unive rsity College of Veterinary
M edi ci ne. Choose only the onl! best answer to each
of the following questions; then mark your an
swers on the test form inserted in Compendium.
1. The dark red or bluish-black color of eight-ball hyphe
ma indicates decreased
a. oxygenation of the animal.
b. ocular b:l ood flow.
e. oxygenarion of erythrocytes in rhe antnior chamber.
d. none of the above
2. Whi c h of the following must be co nsidered 111 cats
with intraocular hemo rrhage?
a. FIr
b, sysremic hypertension
e. T gondii
d , all of the ahove
3. Sampling of aqueo us humor from an eye with hyphe
m<1 to derermine intraocular antibody producrion 15
not indicared because
a. rhere is no inrraocular anribody producrion ,
h. the aqueous humor is conraminared wirh antibod
ies from sysremic circularion,
c. possible complicarions (e.g., a dramaric drop in lOP) .
d, Sampling of aqueous humo r is indicared in eyes
with hyphema.
(COil Tin lies on page 90)
96 " Compendium January 2000

Hyphema (r:u lllinuedfro/1l.page 79)

Index to Advertisers

4 . When hyph ema is presenr, a co mplete hisrory should

include questio ns regardi ng Small Animal

:l. geog raphic locatio n of res idencelrravel history. Haye r Agricultu re Division An imal Hca lr h
b. recent admin is tratio n of medi cati o n. Acivanragc 43
O ro mal Pl us 15
c. pas t illnesseslrecenr visual impairment. Classic M ed ica l S upp ly
d. all of th e above h r:'lsoli ll d Egu ip menr .. .................... 59
Fo rr D odge An im al H ealth
5. In an eye w ith hyphem a, the condition of the re[Ina DUra mllJ1 C' V~l cc i n cs ......... .... ... ......... . ..... ........... ....... ..Co\'r r 4
Pain NlJn:1gCnlcllt f-acr Sheer ............... In se rt
can be assessed with
rnnov'H ive Ve[crina ry Dict's
a. indirect pu pillary light res po nse (if the contralateral I.imircd In grcd ic nr Diets .............. .............. ...... " .. ,.. . ..... ...... 4- 5
pupil is visible). \X'cs tc rn Vere rin ary Conrerence Sym posium " .. .............. .......... 60
Mark ~il o r rL~ Insritut('
b . transcorneal B-mod e ultrasound. Small Animnl Clinicnl lVutrition .. " .............. .. . ......... .34
c. elect ro retinograp hy. lVlt rck Pu hlishin g Gro up
d. all of the above Mack Veterinary Mall ual CD-ROM.. .. ... 53
N:trure's For m lib H C;'l lrh Prod ucts
6. _ _ _ _ __ _ is not caused by topical atro pine.
I.iqu id Her ha l Re m edies ...... .. . ..................................... 16
NOV;lrtis
:l. Mydriasis
C lomicalm .. ,.. .................. " .. . ...... Co'er 2- 1
b. Cycloplegia Progr::l!n .. ............... ....... 26--27
c. Mios is N utral n:LX L~lborJ l ori ('s
C oscquin. . . . . . ...... ..........6
d. Stab iliza tion of the b lood-aqueous barrier Pfizer Animall-l ca lrh
.0 ugh G uard B, Va nguard 5/ B. N3.,aGuard-IJ .... . . ...... 8
7. Use of topical corticosteroids is contraindicated in pa Revolurion.. .. .... ......... .. .. ............ ...... ..... "6~.li 7, 48
Z eni qu in. . ............................... .... ... 22- 23 . 28
tiems with
. .. Schcri nu- Pl ollgh An imal H ea lth
a. antenor UV CltlS. c. corneal ulcer. G;.exy Pa~vo ... .................... . . . ...... ....... 67
b. cataract. d. conjunc[Ivltls. Orb", ............. .... 3 1.32- 33
Synhiori c..')
8. H ow fas t does uncomplicated hyphem a generally resolve? . Wi rn.s. H W .... .. ........... 11
a. 1 day c. 3 month s V e{e~:~h~~~~~~l~~~,~,~,~~~. ~.l,~ . , ................. ... Cover 3

b. 7 to 2 1 days d. 6 monrhs Ve{c rin :l ry Prodllcr.s Labo ram ri t's

Fle:xl;S Plll.~ ........... .. ..................... 71
9. is no t a complication of hyphema.
a. Op tic neu ritis Equine
b. G laucoma
Fo[[ Dodge An imal H ealth
c. Anteri o r and posterior synechiae of the iris Pinn acle l. N . ............. .. . .......... ........ . . ......... ... .. ....... .80
d. Corneal blood staining Ve[sn eam
CD-Eq uis ... ........... ...... .. ........ ......... .. .. .................... .... .......... 85
lO . sho uld nor be used to trea t iridocyclitis.
<l. T opical pilocarpine Food Animal
b. T opical atropi ne
Ve[crinary Learning Systems
c. T opical prednisolone acetate Compendillm Reprillts.... ........ ... ... ..... ... .. ....... .............. ......... 524
d. Systemic prednisolone E11Iery:ency 1\1edicille in Smnll l illimal Prnaice.. ..... ... ......... .52

OCTOBER 1999

QUIZ ANSWERS

ARTICU i #1
;tRTICLE #5
Rena l Effect.'; of Nonste roida l Ant iinflammato ry Drugs-S. D. Fo rrester.
A Prac tili o ne r s Guide In Nccro p, y- E. A. Sartil/ . 1. S. Spalla. T. L Halhcock
G. C. Troy I. b 2. a 3. c 4. d 5. d
I. c 2. d 3. b 4. 5. a 6. d 7. d 8. a 9. e 10. d
6. c 7. <1 8. b 9. 10.d
ARTICLE #6
A RTlCLH#2
Diagnosing Equ in e P rotozoal M yclol! llcepha liti s: Complica [ing Fac[o rs
Ac ute: T horac o lum bar Disk Ext rusion in Dogs. Part (-R . /II!. Jerrol1l.
B. C. Bell I:. W. G. C"ner. T. Tobill
e. lV. f.) (') r n l. d 2. a 3. b 4. 5. a
I. h . 2. 1. J 4. 5. c 6. e 7. d ~ b 9. 10.
6. h 7. c R. J 9. e 10. a
ARTICLE #7
ItRl"ICLE #3 Agr ic ul[ unl l Eco nomics fo r Vetcrin arians: Marketi ng Becf Cow Herds-
The Avia n Re.."Ip iralOry S y s l ~ nl-S. L O/'{H Z: R. L. La rson, V. L. Pierce
I. a 2. e 3. 4. d 5. b I. d 2. e 3. e 4. a 5. e
6. e 7. d R. a 9. h 10. a 6. a 7. b 8. d 9. a 10. c

ARTICLE #4
ARTICLE #8

Basic fl lepharo plasly Techlliqllcs-H. L. Hamilron. R. D. Whilley.

Cryplosporidiox i, - G. L S",kklJ. 1. D. \I{/n BOe llill~. fi. Ridlev. D. Van )\1elre.

S'. t\. M('u(l{ ~h l il1. S. F. Swoilll R. Falkner

I. b 2. d 3. d 4. 5. a I. d 2. a 3. d 4. d 5. e
6. d 7. b 8. e 9. a 10. c 6. d 7. b 8. d 9. a 10. d