To the Editor.—
The reply discussing the circumstances under which patients with traumatic hyphema should be hospitalized1 does not adequately address the complexities or controversies that hyphema management has generated in the ophthalmic literature. For example, it is imperative that all black patients with hyphemas have immediate examination for the presence of sickle cell disease. It has been clearly shown that patients with sickle cell disease or trait do not tolerate elevated intraocular pressure and that the use of acetazolamide is probably contraindicated because the hemoconcentration and acidosis that result exacerbate the sickling process.2 Early surgical intervention may be the best treatment for this type of hyphemainduced glaucoma in patients with sickle cell disease.Other modalities of treatment mentioned in the response are also open to question. The value of systemic steroids in the treatment of hyphema is to date unproved. The only controlled double-blind, prospective study has
Horowitz MA, Schaffer DB, Diamond GR, Katowitz JA, Quinn GE. Management of Traumatic Hyphema. JAMA. 1983;250(22):3046–3047. doi:10.1001/jama.1983.03340220018015
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