Delayed spontaneous hyphema following filtering surgery – A case of swan syndrome

A middle-aged female, three years post combined trabeculectomy and phacoemulsification, presented with sudden onset of pain and blurred vision with no apparent trigger. Possible complications of hyphema, wound leak, hypotony-related maculopathy or bleb-related endophthalmitis were ruled out. Gonioscopy revealed microhyphaema with tuft of vessels at the trabeculectomy ostium with which a diagnosis of Swan syndrome was made. Here we discuss this rare differential of delayed post-operative hyphema which has to be considered in any cases with a history of previous anterior segment surgery. Careful clinical examination is the key factor in arriving at the diagnosis after ruling out all other possible causes.