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