Elevate head of bed and upright position to layer blood by gravity, open visual field while blood resorbs
Eye shield
Pharmacologic control of pain and emesis
Weigh risks and benefits of stopping NSAIDs, ASA, anticoagulants
If IOP elevated (>22) the treatment is similar to glaucoma management except if there is also a concern for a retrobulbar hematoma as a result of trauma. Topical and oral treatments include
Timolol
Topical α-adrenergic agonist
Carbonic anhydrase inhibitors
Consult ophtho regarding:
Dilation of pupil to avoid "pupillary play" -constriction and dilation movements of the iris in response to changing lighting, which can stretch the involved iris vessel causing additional bleeding
Use of topical α-agonists and/or acetazolamide to decrease intraocular pressure
Cycloplegic can be given for comfort and to decease pupillary play if globe rupture has been excluded. Options include:
Tropicamide (Mydriacyl)
Homatropine
Cyclopentolate (Cyclogyl, Cylate, Pentolair)
Scopolamine
Topical steroid
Treat any underlying coagulopathy
Timolol
Topical α-adrenergic agonist
Carbonic anhydrase inhibitors
Dilation of pupil to avoid "pupillary play" -constriction and dilation movements of the iris in response to changing lighting, which can stretch the involved iris vessel causing additional bleeding
Use of topical α-agonists and/or acetazolamide to decrease intraocular pressure
Tropicamide (Mydriacyl)
Homatropine
Cyclopentolate (Cyclogyl, Cylate, Pentolair)
Scopolamine
Traumatic hyphema
Ears
Subdural empyema
Auricular hematoma
Subdural hemorrhage
Nose
Epidural hemorrhage
Nasal fracture