A young 23-year-old black African man presents with a hyphema in the right eye after blunt injury. All of the following are acceptable initial treatments except?
**Core Concept**
The management of hyphema, a condition characterized by accumulation of blood in the anterior chamber of the eye, involves careful monitoring and treatment to prevent complications such as increased intraocular pressure (IOP), cataract formation, and retinal detachment. The initial treatment aims to stabilize the eye, manage pain, and prevent further bleeding.
**Why the Correct Answer is Right**
The primary goal in managing hyphema is to prevent further bleeding from the injured iris or blood vessels. **Elevating the head of the bed** is a crucial step to reduce venous pressure and promote drainage of blood from the anterior chamber. **Corticosteroids** may be used to reduce inflammation and prevent synechiae formation. **Topical beta-blockers** can help lower IOP. However, **systemic corticosteroids** are generally avoided initially due to the risk of increasing intraocular pressure.
**Why Each Wrong Option is Incorrect**
**Option A:** Elevation of the head of the bed is a crucial step in managing hyphema, so this option is acceptable.
**Option B:** Corticosteroids may be used to reduce inflammation and prevent synechiae formation, so this option is acceptable.
**Option C:** Topical beta-blockers can help lower IOP, making this option acceptable.
**Option D:** Systemic corticosteroids are generally avoided initially due to the risk of increasing intraocular pressure, making this option the correct answer.
**Clinical Pearl / High-Yield Fact**
In managing hyphema, it is essential to avoid systemic corticosteroids initially, as they can increase intraocular pressure and worsen the condition.
**Correct Answer: D. Systemic corticosteroids are generally avoided initially due to the risk of increasing intraocular pressure.**