Diagnosis: There really is no differential diagnosis for hyphema, which is the presence of blood in the anterior chamber of the eye.
What matters most is the cause of hyphema, because that governs workup and treatment. Obtain a careful, complete medical history and perform a careful physical examination by both slit lamp and ophthalmoscope. Shield the eye, but do not give aspirin or any other medications capable of producing bleeding. Hyphema is a true ophthalmic emergency, so refer the patient to the emergency department. Hyphema is most often associated with trauma, but consider spontaneous and secondary hyphema due to neovascularization in diabetes, ischemia, and cicatrix formation; ocular neoplasms, such as retinoblastoma and medulloepithelioma; vascular anomalies, such as juvenile xanthogranuloma; and systemic blood disorders such as sickle cell anemia, hemophilia, and von Willebrand disease.
Acknowledgment: Image courtesy of Logical Images, Inc. (www.VisualDx.com/JUCM)