I like it, but any reason you dont indent past one level?
Is that for perlmonks formatting reasons? otherwise it just makes your code harder to follow? just curious....

sub draw_worm {
    my @worm = @_;
    my $head = shift @worm;
    $o->addstr($head->{y}, $head->{x}, '@');
    foreach my $segment (@worm) {
        $o->addstr($segment->{y}, $segment->{x}, 'o');
        if ($bleh) {
             #stuff
        }
    }
}
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