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 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