Surgical intervention in traumatic hyphaemas becomes necessary when high intraocular pressure (IOP) is intractable and there is persistent corneal staining. Anterior chamber (AC) washout and elimination of blood clots have been described previously using one paracentesis. We describe the value of creating two paracenteses. The first one is made in the lower temporal quadrant and accommodates a 20-gauge anterior chamber maintainer (ACM) that is connected to a bottle of Balanced Salt Solution. The second paracentesis is made in an upper quadrant and serves to evacuate liquefied blood and blood clots. With an ACM in place, the fluctuations of intraoperative IOP are minimized and the AC depth is stabilized throughout the operation. The risk of renewed bleeding is reduced because of the continuous positive intraoperative IOP. The ACM is an important tool in the surgical management of traumatic hyphaemas because it facilitates AC washout and reduces iatrogenic damage to the iris and corneal endothelium.
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