Pediatric emergency medicine trisk 3685 3685

Any patient with a fluorescein-staining corneal defect who has a history of
ocular herpes or who wears contact lenses should be referred urgently for
ophthalmology consultation. Fluorescein should not be instilled while patients
have their soft contact lens in place as this may result in permanent discoloration
of the contact lens. Also, judicious use of fluorescein is important; too much will
flood the ocular surface and may lead to false positive findings. Patients who
wear contact lenses should never be patched for abrasions even if the contact lens
has been removed. Patching the eye of a patient who often wears contact lenses
may create a microenvironment that predisposes to bacterial ulceration of the
cornea. The contact lenses should be removed immediately and not worn until the
cornea is healed and topical antipseudomonal topical antibiotics should be
prescribed.

HYPHEMA
CLINICAL PEARLS AND PITFALLS
Patients with hyphemas obscuring the pupil require emergent
ophthalmology consultation; all others require urgent ophthalmologic
evaluation (within 24 hours).
Patients with hyphema are at risk of increased intraocular pressure and
rebleed.
Patients with sickle cell anemia are at particularly high risk for optic
nerve compromise from elevated intraocular pressure; ophthalmology
consultation should be prompt.

Current Evidence
Hyphema can result from either blunt or penetrating trauma to the globe.
Traumatic forces result in shearing of vessels of the iris or ciliary body. In most
patients, bleeding stops quickly as the space is limited, and clotting seals the
vessel. These patients should be treated as an open-globe injury as described
above, with shielding of the eye and emergent consultation with an
ophthalmologist. Patients with clotting disorders and those who take plateletinhibiting medications may be predisposed to hyphema or subsequent

spontaneous rebleeding. Patients with sickle cell disease or trait are at risk of
increased intraocular pressures and rebleeding. Current evidence does not support
the routine use of antifibrinolytics in the treatment of hyphema.

Goals of Treatment