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