A 20-year-old man is hit on the eye with a tennis ball. Examination shows VA 6/24, total hyphaema filling the anterior chamber, and IOP 52 mmHg on maximal medical therapy after 4 hours. What is the most appropriate next step?

• A Observe for 5 days as most hyphaemas resorb spontaneously
• B Immediate trabeculectomy
• C Intravitreal anti-VEGF injection
• D Anterior chamber washout with hyphaema evacuation ✓

Explanation

Total (8-ball) hyphaema with IOP above 50 mmHg for more than 24 to 48 hours, or corneal blood staining risk, are indications for surgical washout. Persistent very high IOP risks optic nerve damage and corneal blood staining. Anterior chamber washout with clot evacuation is the appropriate intervention. Trabeculectomy is not indicated acutely.

Reference: AAO BCSC Section 10: Glaucoma, 2023-2024 ed.

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Written and medically reviewed by the StethoPrep medical team.