Synopsis
Assess blood in the anterior chamber after trauma, exclude associated globe injury, and recognise pressure, rebleeding and sickle-cell risks that change monitoring and escalation.
- Hyphaema is blood within the anterior chamber; microhyphaema contains circulating red cells without an obvious settled fluid level.
- A blunt injury can also damage the lens, retina and drainage angle, so identify associated injuries before treating the blood collection alone.
- Exclude suspected globe rupture before tonometry or contact examination; postpone gonioscopy and scleral indentation in the acute setting.
Key red flags
Increasing pain or a sudden further fall in vision after a traumatic hyphaema may represent rebleeding or raised pressure: seek emergency eye reassessment rather than waiting for the booked review.
Investigation priorities
Identify associated structural damage before undertaking pressure-sensitive examination.
Management branches
Blood is identified or suspected in the anterior chamber following an eye injury.
- Clarify the impact, time course and visual change, looking for signs of rupture and associated head, orbital or posterior segment injury.
- Protect the eye and obtain urgent ophthalmic review; if rupture is suspected, stop contact examination and use the open-globe emergency pathway.
Key medicines
Prednisolone acetate 1% eye dropsFor associated uveitis or photophobia, an ophthalmologist may prescribe one drop up to six times daily, reviewing daily initially and reducing or stopping according to inflammation.
Cyclopentolate 1% eye dropsThe cited NHS hyphaema pathway uses one drop to the affected eye three times daily for associated photophobia or uveitis, with duration determined at close review.