A hyphema is the presence of blood in the anterior chamber and often is a sign of significant trauma. It also can occur spontaneously in sickle cell patients and in patients with coagulopathies. Sight-threatening increases in IOP can occur. In all hyphemas, emergent evaluation by an ophthalmologist is indicated. The patient should be placed either upright or HOB to 30° to 45° to allow the blood to settle inferiorly, which allows faster improvement of vision and facilitates assessment of the hyphema size and posterior pole. A protective eye shield should be in place, except during examination and medication administration. After ruptured globe is excluded, the patient should be evaluated for other eye injuries and treated appropriately. After ruptured globe is excluded, IOP should be measured. A 2001 Cochrane systematic review concluded found no evidence of improved visual acuity with traditional treatments of traumatic hyphema, including antifibrinolytic agents, corticosteroids, cycloplegics, miotics, aspirin, conjugated estrogens, patching, elevation of head, and bed rest. However, antifibrinolytic agents (aminocaproic acid or tranexamic acid) were associated with decreased incidence of rebleeding, but these agents should only be administered by an ophthalmologist. Because of the risk of rebleed in 3 to 5 days and the potential necessity of surgical intervention, any disposition decisions should be made by an ophthalmologist at the bedside, regardless of the size of the hyphema.