SYMPTOMS Blurry vision | Pain
SIGNS Blood in the anterior chamber | Possible corneal blood staining
WORK-UP Thorough history | Slit lamp examination | Dilated fundus exam | Intraocular pressure measurement
Observation | Upright positioning | Strenuous activity is discouraged | Consider placing a metal shield over the eye | Consider discontinuing anticoagulants
Topical IOP-lowering medications may be indicated in the case of IOP spike (brimonidine 0.1% bid) | AVOID prostaglandins as they may increase inflammation
In rare cases, anterior chamber paracentesis may be considered
ADDITIONAL LAB | TESTS Ultrasound biomicroscopy may be used to look for abnormalities or a foreign body, but extreme caution to be gentle is advised
ETIOLOGY Trauma or surgery | Anticoagulant medications or sickle cell disease may be contributory | Vascular abnormalities (i.e. diabetes), neoplasms, and infectious processes that cause neovascularization may result in hyphemas
DIFFERENTIAL DX Microhyphema | Neovascularization
NOTES A 100% black hyphema is commonly referred to as an “8-ball” hyphema | Avoid gonioscopy unless necessary