Hyphaema

What's going on?

This is the result of rupture of a blood vessel on the iris caused by trauma, which then bleeds into the anterior chamber. Usually the vision goes blurry immediately but gradually improves as the blood settles to the bottom of the anterior chamber, forming the hyphaema. The blood cells may occlude the trabecular meshwork, causing the pressure to go up. Bed rest is required to prevent the worrying complication of secondary bleeding. Once the initial clot falls off, at approximately three to five days, there is a danger of further bleeding. This is usually much more severe than the original bleed and can lead to sight-threatening raised intraocular pressure and blood staining of the cornea.

If I examine the patient, what will I find?

There will be blood in the bottom of the anterior chamber. The degree of blood will be variable and may even fill the whole anterior chamber, giving the eye a black appearance – this is called an 'eight ball hyphaema'.

What if I've diagnosed it?

Refer urgently.

What will the hospital do?

The pressure will be checked and the eye examined for other anterior or posterior segment injury. The pupil may or may not be dilated. If the patient is a child, they may be admitted to ensure complete bed rest.

What do I need to do?

Encourage the patient to have strict bed rest if that is what has been advised. They really shouldn't be in your surgery at all.

Problems that may arise, and how to deal with them

If the vision deteriorates suddenly after the initial blurring has resolved, the patient should be re-referred to the hospital, as they may have had another bleed.