Anterior Segment
Hyphaema
Also known as: hyphaema, hyphema, traumatic hyphema, traumatic hyphaema, blood in anterior chamber, layered blood in anterior chamber, microhyphema, microhyphaema
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Blood in the anterior chamber, usually after blunt ocular trauma. Hyphaema is high-risk because it can signal open-globe injury, angle/lens/iris damage, raised IOP, rebleed risk, and systemic bleeding risk. The optometry role is recognition, safe documentation, eye protection, and urgent ophthalmology / ED pathway rather than independent topical steroid or cycloplegic management.
Recognition
Symptoms: what patients report
- Recent blunt ocular trauma or projectile injury.
- Pain, photophobia, tearing, or brow ache.
- Reduced or hazy vision, especially if blood layers across the pupil.
- Nausea/headache if IOP is high.
- History of anticoagulant use, bleeding disorder, or sickle-cell disease/trait increases risk.
Signs: what the examination shows
- Layered blood in the anterior chamber or circulating red blood cells on slit lamp.
- Reduced visual acuity if blood obscures the visual axis or associated injury is present.
- Raised IOP may occur and can be sight-threatening.
- Associated iris sphincter tears, traumatic mydriasis, angle injury, lens injury, corneal injury, or posterior segment trauma may coexist.
- Open-globe signs may include peaked/irregular pupil, shallow or asymmetric anterior chamber, Seidel positivity, uveal prolapse, or very soft/hard globe.
What OptoGuide™ covers for hyphaema
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Hyphema — EyeWiki
- Ophthalmic Trauma Correlation Matrix (OTCM): a potential novel tool for evaluation of concomitant ocular tissue damage in open globe injuries. Khatri A, Shrestha SM, Kuhn F, et al. Graefe's Archive for Clinical and Exper
- Medical Interventions for Traumatic Hyphema. Woreta FA, Lindsley KB, Gharaibeh A, et al. The Cochrane Database of Systematic Reviews. 2023;3:CD005431.
- Pediatric Hyphema. Oboli VN. Pediatrics in Review. 2026;47(5):262-273.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.