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Antifibrinolytic agents in the management of traumatic hyphema.

Clinical confusion often exists when therapeutic alternatives for a particular disease have not been rigorously compared. This problem is typical of the series of clinical decisions required in the management of traumatic hyphema and its complications. For example, should the patient (1) be admitted to the hospital, (2) undergo bilateral or unilateral patching, (3) receive miotics, cycloplegics, or corticosteroids, or (4) receive no therapy? Furthermore, when and how should surgery be performed? Properly obtained clinical data show that beneficial results occur with (1) shielding only the traumatized eye, (2) instillation of topical atropine sulfate, and (3) evaluation of the visual acuity, corneal clarity, and intraocular pressure at least daily. 1,2 Surgical evacuation of blood is indicated when it has been present long enough or has induced high enough intraocular pressure to risk the development of either corneal blood staining or glaucomatous damage to the optic nerve. Specific guidelines regarding timing