What is a recommended initial management step in hyphema?

• A. Decrease intraocular pressure and sleep with the head of bed elevated
• B. Immediate surgical removal
• C. Initiate high-dose steroids
• D. Patch the eye

Answer: (A)

In hyphema, the most important early step is to minimize ongoing bleeding and protect the optic nerve by lowering intraocular pressure and reducing orbital venous pressure. Keeping the head elevated (about 30–45 degrees) decreases venous pressure in the eye, which helps prevent rebleeding from injured iris vessels, and supports lower intraocular pressure. This conservative approach addresses the immediate risks before considering more invasive or targeted therapies. Immediate surgical removal is reserved for persistent or large hyphemas with elevated pressure or vision-threatening situations. High-dose steroids don’t rapidly address bleeding or pressure, and patching the eye protects but doesn’t tackle the underlying risk.