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The goals of treatment in the ED are as follows: (1) prompt recognition, (2)
assessment of the level of urgency of definitive ophthalmologic management, and
(3) emergent consultation with ophthalmology if there is a concern for elevated
pressure, severe pain, hyphema covering the pupil, sickle cell disease, or visual
acuity diminished past 20/200.

Clinical Considerations
Clinical Recognition
The presence of blood between the cornea and the iris is a sign of severe ocular
trauma. Although the entire anterior chamber may be filled with blood, clots may
also be small, requiring careful inspection for detection ( Fig. 114.10 ).
Sometimes the blood is more diffuse throughout the anterior chamber or may
even be microscopic, requiring slit-lamp examination for detection
(microhyphema). Patients with hyphema are vulnerable to spontaneous
rebleeding for the first 5 days after injury. Patients with sickle cell anemia are at
particular risk for ocular complications of hyphema.

FIGURE 114.10 Hyphema. This 7-year-old girl was struck by a hard rubber ball and presented
with blurred vision. The 1-mm hyphema was only visible when she was upright. (Reprinted
with permission from Fleisher GR, Ludwig S, Baskin MN. Atlas of Pediatric Emergency
Medicine . Philadelphia, PA: Lippincott Williams & Wilkins; 2004:403.)

Triage Considerations