A slit lamp exam needs to be done to quantitate the amount of the bleed, and also to assess for corneal damage or the presence of foreign bodies. The lens should be assessed for dislocation or traumatic cataract. Several sources suggest leaving the dilatation and intraocular pressure measurement to the ophthalmologist. This is particularly true in children. If there is doubt about the possibility of coexisting head injury, this should be addressed.
Blood occupies less than one-third of the anterior chamber volume.
Patients with sickling hemoglobinopathies have a high risk of developing glaucoma even with small hyphemas, because the environment of the anterior chamber is conducive to the formation of sickled red blood cells. Increased intraocular pressure may be the result of a hyphema of any grade, but is more likely to result from large hyphemas. If the intraocular pressure rises abruptly the patient may appear acutely ill and in distress from the pain associated with the elevated pressures. Later, fibrosis of the trabecular meshwork, posterior synechia formation, or other scarring may result in a persistent increase in the intraocular pressure. Persistent increased intraocular pressure may irreversibly damage the optic nerve.