Outpatient treatment of microscopic and rim hyphemas in children with tranexamic acid.

Twenty-one patients aged 4 to 15 years with microscopic or rim hyphemas were treated as out-patients with systemic tranexamic acid therapy. The protocol included limited activity at home, topical steroid therapy, no dilating drops, patching for comfort or surface abrasions only, and follow-up every 24 to 48 hours. With this regimen no patient had a secondary hemorrhage. The incidence of associated injuries was surprisingly high, including four patients with angle recession, two with choroidal ruptures and four with commotio retinae, two of whom manifested retinal holes, requiring cryotherapy. We conclude that tranexamic acid therapy decreases the risk of secondary hemorrhage in ambulatory patients with hyphema, but careful assessment and follow-up are necessary to rule out associated ocular injury.