Abstract
Iris microhaemangiomas, or Cobb's tufts, are rare, benign vascular lesions that may cause spontaneous hyphema and elevated intraocular pressure, risking vision loss. Due to the rarity of these cases, there is no consensus on acute management. We present a case of a woman in her seventies who presented with right eye pain and blurred vision due to spontaneous hyphema secondary to active bleeding from a vascular tuft. Conservative measures, including mydriatics and compression, failed to control the haemorrhage. After multidisciplinary consultation, 1 gram of intravenous tranexamic acid was administered, achieving haemostasis within 30 minutes without adverse effects. Imaging confirmed bilateral iris microhaemangiomas. Over six months of follow-up, the patient's vision and intraocular pressures remained stable with no recurrence. This case suggests intravenous tranexamic acid may be a low-risk and effective option for managing spontaneous hyphema secondary to iris microhaemangiomas when initial treatments are unsuccessful.