OP6.3 | Hyphema and Hypopyon: Clinical Distinction and Causes — Summary & Reflection

KEY TAKEAWAYS

Hyphema = blood in the anterior chamber — red/dark red horizontal level; most commonly traumatic (iris root vessel tear from blunt trauma); graded I (< 1/3 AC) to IV (total/'8-ball'). Complications: rebleed (day 2–5), corneal blood staining (total hyphema + high IOP), secondary glaucoma; sickle cell disease: avoid systemic acetazolamide, increased IOP risk. Hypopyon = white/cream layered cells in inferior AC — sterile (iridocyclitis, Behçet's disease, TASS) or infective (bacterial/fungal endophthalmitis, penetrating trauma). The critical distinction: infective hypopyon + vitreous haze = post-operative/post-traumatic endophthalmitis = immediate vitreous tap + intravitreal antibiotics (vancomycin + ceftazidime). TASS (sterile) presents <24 hours post-op, clear vitreous, responds to topical steroids. Behçet's hypopyon: migratory, bilateral, systemic triad (oral ulcers + genital ulcers + uveitis). Management hyphema: bed rest 30° head elevation, eye shield, cycloplegia, IOP control, avoid aspirin; surgery for persistent total hyphema. Management hypopyon: treat the aetiology — steroids for sterile; immediate intravitreal antibiotics for infective.

REFLECT

Consider the two patients from the opening scenario. Patient A (cricket ball injury with hyphema) is straightforward once the diagnosis is confirmed — but what if he had sickle cell trait? How would this change your management immediately? Patient B (post-operative hypopyon with vitreous haze) — imagine you are the only ophthalmologist available and the senior is not contactable for the next 2 hours. What would you do? Reflect on the principle that endophthalmitis is the one diagnosis in ophthalmology where waiting for a consultant before acting is itself a wrong decision. Think also about your communication with Patient A's family: how would you counsel them about the risk of rebleed, the signs to watch for, and why rest at home for the next week is not optional?