Hyphema is defined as blood in the anterior chamber of the eye, mainly resulting from trauma, with grading based on the level of blood accumulation. Management includes rest, medication, and potentially surgical intervention, with hypopyon being pus accumulation in the anterior chamber, indicating severe inflammation often due to infection. Both conditions present with specific symptoms and signs, require careful diagnosis, and can lead to serious ocular complications.

1. HYPHEMA and
HYPOPYON

2. Definition:
Blood in the anterior chamber of eye is called
Hyphema.
Hyphema

3. Pathophysiology:
• Compressive force to the globe or trauma can result
in injury to the iris, ciliary body, trabecular
meshwork, and their associated vasculature. The
shearing forces from the injury can tear these vessels
and result in the accumulation of blood cells within
the anterior chamber.
Fig; Bleeding from the ciliary body

4. • Grade 0: No visible layering, but red
blood cells within the anterior
chamber (microhyphaema)
• Grade I: Layered blood occupying less
than 1/3 of the anterior chamber
• Grade II: Blood filling 1/3 to 1/2 of
the anterior chamber
• Grade III: Layered blood filling ½ to
less than total of the anterior
chamber
• Grade IV: Total clotted blood, often
referred to as blackball or 8-ball
hyphaema
GRADING

5. PRESENTATION

6. PRESENTATION
• Symptoms:
Symptoms can be variable depending on the
etiology. Typically patients complain of blurry
vision, pain, headahce, photophobia, H/O
trauma.
• Signs:
Blood or clot or both in the AC, usually visible
without a slit lamp.

7. MANAGEMENT

8. TREATMENT
1.Sedation or complete bed rest with limited
activites.
2. Cycloplegics; Atropine 1% E/D
3. Anti inflamatoty
- Steroids, mild NSAIDs
4.Ocular hypotensive agents in case of IOP
5.Place shield or patch over eye
6. Rx of the cause
7.(surgically) A/C paracentesis with irrigation
and aspiration

9. Hypopyon
• Definition:
Hypopyon is the accumulation of pus in the anterior
chamber, consisting of white blood cells, fibrin, and
inflammatory debris. It is often a sign of severe
intraocular inflammation.

10. Common Causes:
Infective Keratitis:
Bacterial (e.g., Pseudomonas,
Staphylococcus, Streptococcus).
Fungal (e.g., Aspergillus, Fusarium).
Viral (e.g., Herpes Simplex Virus).
Autoimmune Uveitis:
Behçet’s disease.
HLA-B27 associated uveitis.
Other Causes:
Endophthalmitis.
Post-surgical infections.

11. Clinical Features
Symptoms:
Pain and redness.
Photophobia.
Decreased vision.
Signs:
Yellowish-white layering of pus in the anterior
chamber.
Corneal haze or edema.
Severe conjunctival injection.
Possible corneal ulceration in infective cases.

12. Hyphema Hypopyon
Content Blood Pus
Color Red to dark red Yellowish-white
Causes Trauma (blunt or
penetrating)
Blood disorders (e.g.,
sickle cell anemia)
Anticoagulant therapy
Infective keratitis
(bacterial, fungal)
Autoimmune uveitis
Systemic inflammatory
conditions
Associated Conditions Increased IOP, risk of
rebleeding
Corneal ulceration,
endophthalmitis,
systemic involvement
(e.g., Behçet’s disease)