›Avoid pressure patch if hyphema or open globe concern
›Head of bed elevation
›30 to 45 degrees
›Continuous while resting
›Antiemetic to prevent Valsalva
›Ondansetron dosing per Medications section
›Escalate if ongoing emesis
›Analgesia without platelet inhibition
›Acetaminophen dosing per Medications section
›Opioid if severe pain local protocol dependent
Diagnostic sequencing
›Diagnostic sequencing
›Visual acuity before drops if possible
›Open globe screen before tonometry
›Slit lamp with hyphema grading
›CT orbit if foreign body or fracture concern
Hyphema management
›Hyphema management
›Activity restriction
›Bed rest relative
›Avoid heavy lifting and straining
›Cycloplegia
›Cyclopentolate 1 percent per ophthalmology
›Alternatives local protocol dependent
›Topical steroids
›Prednisolone acetate 1 percent per ophthalmology
›Avoid if corneal epithelial defect without ophthalmology guidance
›Intraocular pressure control
›Timolol 0.5 percent if elevated pressure and no contraindications
›Add brimonidine 0.2 percent local protocol dependent
›Avoid carbonic anhydrase inhibitors in sickle cell disease local protocol dependent
›Bleeding avoidance
›Avoid NSAIDs and ASA
›Review anticoagulants and antiplatelets
Orbital compartment syndrome pathway
›Orbital compartment syndrome pathway
›Time critical criteria
›Rapid vision decline
›Proptosis with tense orbit
›Lateral canthotomy and cantholysis
›If ophthalmology unavailable and vision threatened local protocol dependent
›Post procedure intraocular pressure reassessment
Reassessment loop
›Reassessment loop
›Visual acuity trend
›Pain trend
›Hyphema height trend
›Intraocular pressure trend if measured safely
17Disposition/dispo18
Ophthalmology consultation and follow up timing
›Ophthalmology consultation and follow up timing
›Same day ophthalmology
›Any layered hyphema
›Elevated intraocular pressure
›Immediate transfer
›Open globe concern
›Orbital compartment syndrome concern
Admission and observation criteria
›Admission and observation criteria
›Total hyphema
›Hyphema grade 3 or 4
›Uncontrolled intraocular pressure
›Sickle cell disease or trait with hyphema
›Nonadherence risk to activity restriction
Discharge criteria
›Discharge criteria
›Stable vision
›Mild hyphema with reliable follow up
›Controlled pain and nausea
›Clear instructions and eye shield available
18Discharge Instructions/di26
Copy discharge instructions
›Copy discharge instructions
›Diagnosis
›You have bleeding in the front chamber of the eye after trauma
›This can worsen again within the next week
›Eye protection
›Keep the rigid eye shield on except for drops
›Do not rub or press on the eye
›Position and activity
›Sleep with head raised
›Avoid heavy lifting
›Avoid straining
›Avoid sports until cleared
›Medications
›Use eye drops exactly as prescribed
›Use acetaminophen for pain
›Do not take ibuprofen, naproxen, or ASA unless instructed
›Follow up
›Ophthalmology appointment
›Timing per ED plan
›Return to ED now for
›Worsening vision
›Increasing eye pain
›New nausea or vomiting
›New flashing lights
›New curtain or shadow in vision
›Eye swelling with bulging appearance
19References/r13
Guidelines and key sources
›Guidelines and key sources
›American Academy of Ophthalmology
›Eye trauma and hyphema clinical guidance
›Year varies local protocol dependent
›Wills Eye Manual
›Ocular trauma management approach
›Updated editions local protocol dependent
›British Ocular Trauma Society
›Ocular trauma standards and terminology
›Year varies local protocol dependent
›Ocular Trauma Score
›Prognostic tool validation studies
›Use in severe ocular trauma
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.