Traumatic hyphema is always potentially dangerous. Total hyphema ("eight-ball hemorrhage") has an especially poor prognosis because it often results in glaucoma, iris atrophy, and hematogenous pigmentation of the cornea.
The types of treatment advocated for traumatic hyphema include bed rest, sedatives, miotics, mydriatics, carbonic anhydrase inhibitors, and cold compresses. Some favor repeated paracenteses if the intraocular pressure rises.2 Early paracentesis and injection of air have been advocated.3 When there is secondary bleeding and the anterior chamber becomes filled with blood, many operators advocate early surgery with irrigation and manual removal of clot.1 Enzymatic dissolution of hyphema has also been attempted. Results with intramuscular trypsin are equivocal.4,5
Jukofsky6 first suggested the use of streptokinase. When rabbit blood was injected into rabbit eyes with streptokinase, clots dissolved, but corneas became opaque. One total hyphema in a human patient cleared. Adverse reactions to streptokinase, including chemosis and iritis,