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Hyphema in Cats

Hyphema, or blood in the anterior chamber of the eye, is a common condition among cats. However, hyphema is a clinical sign and not a specific disease in itself.

Symptoms and Types

The symptoms of hyphema are dependent on the extent of bleeding, whether vision has been impaired, and whether your cat has other systemic diseases.

The most common signs found during a physical examination are:

• Blood within the anterior chamber of the eye
• Corneal edema or corneal lesions
• Intraocular Pressure (IOP) may be elevated

Causes

The most common causes of hyphema are:

• Injury, trauma to the eye or head
• Severe retinal detachment
• Hypertension, hyperthyroidism, systemic deficiencies
• Infection by parasites
• Bleeding of the vessels, vasculitis, uveitis, uveal neoplasia, and particularly lymphoma
• Ocular defects - retinal dysplasia, glaucoma, etc.

Hyphema can also be indicative of various ocular and systemic deficiencies. Therefore, diagnosis and proper treatment is very important.

Diagnosis

Hyphema is diagnosed through hematology and blood biochemistry, lab tests, and diagnostic imaging using X-rays and ultrasound tests.

A complete medical history is taken and a thorough physical examination is performed to include or exclude possible causes.

Common diagnostic tests and procedures include:

• Complete blood count with platelet count
• Serum biochemistry to measure serum levels in protein
• Coagulopathy tests to assess blood coagulation functions
• Blood pressure
• Urinalysis, to exclude kidney diseases
• Chest and abdominal X-rays
• Ocular ultrasounds (ultrasonography) to investigate the anterior portion of the eye and include or exclude possibilities of retinal detachment, lens displacement, abnormal masses, and vitreal hemorrhage

Other advanced tests that may be performed include abdominal ultrasounds, X-rays of the head and eye orbit to detect traumatic injuries, and hormonal tests (assays) of the adrenal glands. To detect bone marrow cancer, a bone marrow aspirate - the liquid found within the bone marrow - may also be done.

Treatment

The objectives of hyphema treatment involve containing the inflammation and removing the underlying causes which contribute to bleeding in the anterior chamber of the eye.

The common approaches to treatment are:

• Use of corticosteroids as eye drops or ointment to cure inflammation arising out of the bleeding
• Atropine eye drops to dilate the pupil, which minimizes sticking between the lens and the iris
• Initiation of appropriate treatment for ocular deficiencies like retinal abnormalities (i.e., dysplasia), glaucoma, etc.

Surgery may also be necessary for correcting traumatic injuries and lesions.

Your cat's activity will need to be restricted if the problem has been caused by a clotting disorder, since clots can quickly become fatal with movement of blood through the arteries. In addition, if hyphema has significantly damaged your cat's vision, the cat should not be allowed to go outside without close supervision. Regular monitoring of the fluid pressure within the eye is also very important - daily for severe diseases and in less severe cases, every two to three days until it clears up. To prevent further injury to the eye, your veterinarian can provide you with an Elizabethan collar, so that your cat cannot scratch at its eye.

Unless irreversible damage has been caused to the ocular structures, the prognosis is usually good in cases of eye trauma. If retinal detachment has occurred, secondary glaucoma will eventually develop, and surgical intervention may be necessary for the relief of pain.