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Fuch’s heterochromic iridocyclitis (FHI) is a unilateral ocular condition characterised by low-grade anterior uveitis. Although the underlying aetiology remains unclear, proposed triggers include infections, autoimmune mechanisms and genetic predisposition. Amsler’s sign is a recognised complication of FHI whereby patients develop spontaneous hyphaema that is often self-limiting. Current management of FHI focuses on managing complications such as raised intraocular pressures (IOPs), secondary glaucoma and formation of cataracts rather than the inflammation itself. In this case report, we present a patient with FHI complicated by spontaneous hyphaema and acute-on-chronic ocular hypertension refractory to medical therapy. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) ranibizumab was used, which achieved rapid resolution of hyphaema with resultant reduction in IOP. Subsequent trabeculectomy was performed for definitive control of persistent chronic ocular hypertension. This case highlights anti-VEGF therapy as a potential adjunctive strategy in selected patients presenting with similar clinical challenges.