Hyphaema

Natasha Mitchell

doi:10.22233/9781910443149.5.19

Hyphaema

British Small Animal Veterinary Association , 244 (2013); https://doi.org/10.22233/9781910443149.5.19

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Hyphaema

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Author: Natasha Mitchell
From: BSAVA Manual of Feline Practice
Item: Chapter 5.19, pp 244 - 247
DOI: 10.22233/9781910443149.5.19
Copyright: © 2013 British Small Animal Veterinary Association
Publication Date: January 2013

Abstract

Hyphaema is the term used to describe the presence of blood in the anterior chamber. The entire chamber may be filled with blood (total hyphaema), or there may be a focal haemmorrhage. Hyphaema can affect one eye or both eyes. This condition presents a diagnostic challenge, as the presence of blood could prevent thorough inspection of the inside of the eye. This chapter considers causes, clinical approach, treatment plan and prognosis.

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Figures

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5.19.2

Bilateral intraocular haemorrhage in a hypertensive cat at initial presentation. In the left eye the hyphaema has settled ventrally with gravity, so that the dorsal half of the iris and pupil are visible. The fundus was examined through this and the retina was found to be detached. Haemorrhage in the vitreous of the right eye prevented fundus examination; the iris is visible because the haemorrhage is behind it, in the vitreous. There are some unrelated patches of pigment visible on the right iris, which are iris naevi or ‘freckles’. © 2013 British Small Animal Veterinary Association

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5.19.2 Bilateral intraocular haemorrhage in a hypertensive cat at initial presentation. In the left eye the hyphaema has settled ventrally with gravity, so that the dorsal half of the iris and pupil are visible. The fundus was examined through this and the retina was found to be detached. Haemorrhage in the vitreous of the right eye prevented fundus examination; the iris is visible because the haemorrhage is behind it, in the vitreous. There are some unrelated patches of pigment visible on the right iris, which are iris naevi or ‘freckles’.

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5.19.3

(a) Blunt trauma has caused corneal oedema (white area to the left of the picture) and hyphaema with an organizing blood clot, multifocally adhered to the yellow iris. There are small gaps visible between the blood clot and the iris (arrowed), which are important for the circulation of aqueous humour. (b) Hyphaema from a cat claw injury on the upper eyelid. There is chemosis (bulging conjunctiva visible both dorsally and ventrally), conjunctival hyperaemia and mild corneal oedema, making the iris look dull. © 2013 British Small Animal Veterinary Association

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5.19.3 (a) Blunt trauma has caused corneal oedema (white area to the left of the picture) and hyphaema with an organizing blood clot, multifocally adhered to the yellow iris. There are small gaps visible between the blood clot and the iris (arrowed), which are important for the circulation of aqueous humour. (b) Hyphaema from a cat claw injury on the upper eyelid. There is chemosis (bulging conjunctiva visible both dorsally and ventrally), conjunctival hyperaemia and mild corneal oedema, making the iris look dull.

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5.19.4

Uveitis with neovascularization of the iris (rubreosis iridis) due to PIFM formation. The fragile vessels are leaking protein (causing cloudy aqueous flare) and fibrin (forming a central cream-coloured clot (red arrow) in the anterior chamber), but not yet frank blood. Episcleral congestion is visible laterally (black arrow). © 2013 British Small Animal Veterinary Association

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5.19.4 Uveitis with neovascularization of the iris (rubreosis iridis) due to PIFM formation. The fragile vessels are leaking protein (causing cloudy aqueous flare) and fibrin (forming a central cream-coloured clot (red arrow) in the anterior chamber), but not yet frank blood. Episcleral congestion is visible laterally (black arrow).

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5.19.5

Fibrin and haemorrhage in the ventral aspect of the anterior chamber. The pupil is an abnormal shape (dyscoria) due to a pleated fold in the lateral iris (arrowed). The pigmented posterior surface of the iris is everted at the pupil margin (termed ectropion uveae). Lymphoma was subsequently diagnosed. © 2013 British Small Animal Veterinary Association

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5.19.5 Fibrin and haemorrhage in the ventral aspect of the anterior chamber. The pupil is an abnormal shape (dyscoria) due to a pleated fold in the lateral iris (arrowed). The pigmented posterior surface of the iris is everted at the pupil margin (termed ectropion uveae). Lymphoma was subsequently diagnosed.

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5.19.6

Neovascularization of the dorsal and lateral iris, due to a PIFM, along with corneal oedema. Conjunctivitis is visible dorsolaterally. There is mild corneal oedema throughout, obscuring a clear view of the iris, and the pupil is mid-dilated which was due to glaucoma. The PIFM can bleed, causing subsequent hyphaema (not present here). © 2013 British Small Animal Veterinary Association

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5.19.6 Neovascularization of the dorsal and lateral iris, due to a PIFM, along with corneal oedema. Conjunctivitis is visible dorsolaterally. There is mild corneal oedema throughout, obscuring a clear view of the iris, and the pupil is mid-dilated which was due to glaucoma. The PIFM can bleed, causing subsequent hyphaema (not present here).

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5.19.7

Total hyphaema causing a dark red appearance to the eye. There are two areas of subconjunctival haemorrhage visible ventrally. This cat had rodenticide (flucoumafen) poisoning. © 2013 British Small Animal Veterinary Association

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5.19.7 Total hyphaema causing a dark red appearance to the eye. There are two areas of subconjunctival haemorrhage visible ventrally. This cat had rodenticide (flucoumafen) poisoning.

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5.19.8

Ocular ultrasonography. The cat is gently restrained and a drop of topical anaesthetic is applied to the cornea. Coupling gel (e.g. K-Y jelly) is applied to the cornea, and the transducer is then gently applied directly to the cornea. Higher frequencies such as 7.5 or 10 MHz achieve the best resolution in the eye. © 2013 British Small Animal Veterinary Association

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5.19.8 Ocular ultrasonography. The cat is gently restrained and a drop of topical anaesthetic is applied to the cornea. Coupling gel (e.g. K-Y jelly) is applied to the cornea, and the transducer is then gently applied directly to the cornea. Higher frequencies such as 7.5 or 10 MHz achieve the best resolution in the eye.

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5.19.9

Ultrasound image of a normal feline eye. (1) The cornea – visible as a white line. The space between arrows 1 and 2 is the anterior chamber – it is black as it contains fluid. (2) The anterior lens capsule – visible as a white line. In the space between arrows 2 and 3 the lens appears black (it would be white if there were a cataract). (3) The posterior lens capsule – visible as a white line. In the space between arrows 3 and 4 the vitreous is liquid and appears black. (4) Posterior border of the globe – retina, choroid and sclera. (Courtesy of John Mould) © 2013 British Small Animal Veterinary Association

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5.19.9 Ultrasound image of a normal feline eye. (1) The cornea – visible as a white line. The space between arrows 1 and 2 is the anterior chamber – it is black as it contains fluid. (2) The anterior lens capsule – visible as a white line. In the space between arrows 2 and 3 the lens appears black (it would be white if there were a cataract). (3) The posterior lens capsule – visible as a white line. In the space between arrows 3 and 4 the vitreous is liquid and appears black. (4) Posterior border of the globe – retina, choroid and sclera. (Courtesy of John Mould)

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5.19.10

(a) The right eye of a 10-year-old cat with hyphaema almost filling the anterior chamber; a small section of the iris can be seen dorsally. (b) Ultrasound image, highlighting a mass within the iris. (1) The cornea. (2) The iris resting on the anterior lens capsule. (3) The posterior lens capsule. (4) The retina, choroid and sclera. The yellow outline delineates the mass. Continued rebleeding occurred due to PIFM, and the eye was later enucleated. Histology confirmed an iris melanoma. © 2013 British Small Animal Veterinary Association

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5.19.10 (a) The right eye of a 10-year-old cat with hyphaema almost filling the anterior chamber; a small section of the iris can be seen dorsally. (b) Ultrasound image, highlighting a mass within the iris. (1) The cornea. (2) The iris resting on the anterior lens capsule. (3) The posterior lens capsule. (4) The retina, choroid and sclera. The yellow outline delineates the mass. Continued rebleeding occurred due to PIFM, and the eye was later enucleated. Histology confirmed an iris melanoma.

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5.19.11

The eye in Figure 5.19.3b photographed 6 weeks later. There is a central resolving blood clot in the anterior chamber, with surrounding fibrin (white arrow) and synechiae to the iris (black arrow). © 2013 British Small Animal Veterinary Association

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5.19.11 The eye in Figure 5.19.3b photographed 6 weeks later. There is a central resolving blood clot in the anterior chamber, with surrounding fibrin (white arrow) and synechiae to the iris (black arrow).

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5.19.12

The cat in Figure 5.19.2 photographed 4 weeks after amlodipine treatment. There is restoration of vision, reabsorbed vitreal haemorrhage in the right eye, and a resolving blood clot in the left anterior chamber. There are anterior synechiae from the blood clot to the iris (arrowed). The iris freckles are obvious on the lateral aspect of the right iris; this is benign pigmentation but should be monitored in case melanoma develops. © 2013 British Small Animal Veterinary Association

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5.19.12 The cat in Figure 5.19.2 photographed 4 weeks after amlodipine treatment. There is restoration of vision, reabsorbed vitreal haemorrhage in the right eye, and a resolving blood clot in the left anterior chamber. There are anterior synechiae from the blood clot to the iris (arrowed). The iris freckles are obvious on the lateral aspect of the right iris; this is benign pigmentation but should be monitored in case melanoma develops.