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Hyphema in Dogs

By: Dr. Noelle McNabb

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Diagnosis In-depth

  • A complete medical history is obtained and a thorough physical examination performed. Be sure to tell your veterinarian if you are aware of any potential exposure to toxins or poisons, any head or eye trauma, the rate of onset of the bleeding (sudden or slowly progressive), medications currently being given, ongoing medical conditions or recently observed physical abnormalities of your pet.

  • Complete ophthalmic examination usually includes examination of the interior of the eye under magnification, staining of the cornea with fluorescein, and tonometry to detect glaucoma. It is important to determine the extent of the hyphema, whether it is confined to the anterior chamber, whether the posterior part of the eye is also involved, and if the condition exists in one or both eyes. Your veterinarian may refer your dog to a veterinary ophthalmologist for further evaluation of the hyphema using specialized instrumentation.

  • Complete blood count (CBC) including a platelet count are performed to look for evidence of infection/inflammation and to ensure there are adequate numbers of platelets present.

  • A serum biochemistry panel is run to evaluate organ functions and to measure protein levels in the serum.

  • Specialized blood tests to evaluate blood clotting ability

  • Blood pressure testing determines if the dog has elevated blood pressure.

  • A urinalysis may be performed if there is a suspicion of kidney disease.

  • Chest and abdominal X-rays may be recommended if there is evidence of other organ abnormalities on the blood test results.

    Your veterinarian or veterinary ophthalmologist may recommend further diagnostic tests to search for other conditions in the body or to evaluate how much damage is present in the eye. Some commonly performed additional tests include:

  • Serology tests designed to detect the systemic tick-borne diseases, such as Ehrlichiosis, and Rocky Mountain spotted fever

  • Ocular ultrasonography, which is an imaging technique that shows the structures in the back part of the eye and behind the eye. This test is particularly helpful when the hyphema is so severe that the back part of the eye cannot be examined with the usual instruments. Ultrasonography helps to identify the presence of abnormal masses within the eye, lens displacement (luxation), retinal detachment or vitreal hemorrhage. A veterinary ophthalmologist or radiologist may perform or interpret of this test for your veterinarian.

  • Radiographs of the head and orbit (bony socket for the eye) may be necessary to identify fractures in dogs that have sustained head injuries. Plain X-rays are also useful to identify any metal foreign objects like gunshot pellets or BBs lodged in the area.

  • Hormonal assays of the adrenal gland may be recommended if high blood pressure was detected.

  • Abdominal ultrasonography may be recommended if there is evidence on the laboratory tests that certain organs in the abdomen are not functioning well, or that there may be cancer in the abdomen.

  • A bone marrow aspirate (cell collection from the bone marrow) may be done to evaluate the bone marrow's ability to produce platelets or to search for cancer of the bone marrow.

    Therapy In-depth

    The goals of treatment of hyphema are two-fold: to treat the inflammation that arises in the eye from the bleeding and to treat any underlying causes of the bleeding. Treatment of the hyphema itself involves the following:

  • Topical corticosteroids, in the form of eye drops or ointment, are used to reduce inflammation within the anterior chamber.

  • Topical atropine, in the form of eye drops or ointment, is indicated to dilate the pupil. Dilation of the pupil helps to relieve pain and to minimize adhesions between the iris and the lens.

  • Treatment for glaucoma, whether it initiated the hyphema or developed as a result of the bleeding, is indicated if pressures within the eye are elevated. See the Client Education article on Glaucoma.

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