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JAMA Ophthalmology Clinical Challenge
April 26, 2018

Spontaneous Hyphema in a Middle-Aged Woman

Author Affiliations
  • 1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. Published online April 26, 2018. doi:10.1001/jamaophthalmol.2017.6058

A white woman in her late 50s with a history of breast cancer and primary biliary cirrhosis presented with spontaneous hyphema with elevated intraocular pressure in the left eye, which was treated topically with corticosteroid eyedrops, cycloplegia, and an aqueous suppressant. There was no history of eye trauma, oral anticoagulant use, or bleeding disorder. On examination 4 months after the initial presentation, the hyphema in the left eye had resolved and the patient was no longer using topical medications. Visual acuity was 20/20 OU and there was no relative afferent pupillary defect. Intraocular pressure, ocular motility, and confrontation visual fields were normal in both eyes. Slitlamp biomicroscopy showed a normal iris except for pinpoint focal wisps of fibrosis at the pupillary margin in both eyes (Figure, A). The anterior chamber was deep and quiet without cell or flare in both eyes. Findings from fundus examination were normal in both eyes. Anterior segment fluorescein angiography (FA) demonstrated several tiny, pinpoint foci of hyperfluorescence with leakage at the iris pupillary margin in both eyes (Figure, B).

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