Hyphema: เรื่องใกล้ตาที่ไม่น่าพลาด

ภาวะเลือดออกในช่อง Anterior chamber หน้าเลนส์​ เป็นอีก ภาวะบาดเจ็บที่พลาดกันได้บ่อย ทั้งการตรวจพบและแนวทางใน การรักษา การตรวจตาผู้บาดเจ็บอยู่ในขั้น Secondary survey (ใน Primary survey ดูแค่ pupil) เมื่อผู้บาดเจ็บอยู่ในท่ายืนหรือนั่ง จะเห็นเป็นระดับของเลือดจากการตกลงสู่เบื้องล่างของเม็ดเลือด แต่หากตรวจในท่านอนหงาย จะไม่เห็นระดับดังกล่าว ถ้ามีเลือด ออกไม่มาก อาจทำให้พลาดได้ง่าย จึงต้องอาศัยความช่างสังเกต,​ช่างสงสัยของผู้ประเมิน แนวทางในการรักษา แยกออกตามกลไกการบาดเจ็บเป็น

o Penetrating injury ต้องมองหาว่ามี Ruptured cornea หรือ Ruptured globe ร่วมด้วยหรือไม่ (ถ้ามีต้องรักษาด้วย)

o Blunt injury แนะนำให้นอนหัวสูง ประมาณ 30 องศา ร่วมกับ Absolute bed rest,​ ปิดตา ให้ยาแก้ปวด, sedate ที่สำคัญคือ Admit เพื่อเฝ้าระวังภาวะความดันในลูกตาเพิ่ม สูงขึ้น (Increased intraoccular pressure) และเกิดเลือดออกซ้ำ (Re-bleeding) ในช่วง 3 วัน โดยพบว่า Re-bleeding รุนแรงกว่า ครั้งแรกได้

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