History

• 55 year old male struck with unknown object in a bar fight
• He was found down for an unknown amount of time
• He denies pain or vision changes

Physical Exam

• Note the red (blood) in the anterior chamber
• The complete filling of the anterior chamber is known as an "8 ball hyphema"
• IOP is measured at 15 mm Hg bilaterally
• Fluorescin stain is negative

Management

• Elevate head of bed
• Consider globe rupture and place eye shield
• Monitor IOP
• Manage elevated IOP as per acute angle closure glaucoma - clotted blood clogs the trabecular meshwork and prevents drainage of aqueous humor
• Emergent opthalmology consult