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more significant cases, the pupil often takes on a teardrop appearance, with the
narrowest segment pointing toward the opening ( Fig. 114.5 ). A teardrop pupil is
a worrisome indicator that an open-globe injury likely occurred. In addition, if
there is 360-degree subconjunctival hemorrhage, one may be unable to see if a
scleral laceration is present. Patients who present following trauma with severe
360-degree conjunctival swelling should be treated as if they have an open-globe
injury and should be referred immediately to an ophthalmologist. Hemorrhage
within the anterior chamber (hyphema) may accompany a corneal or anterior
scleral laceration ( Fig. 114.4 ).
FIGURE 114.3 Open globe with teardrop pupil.