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Question: What medication should you avoid in a sickle-cell patient with a hyphema?

Answer: You should avoid carbonic anhydrase inhibitors, both topical drops and oral diamox, as this medication acidifies the aqueous fluid and promotes more sickling. With hyphemas, the trabecular meshwork can get clogged up with blood cells, and sickled cells make this situation worse. To treat high eye pressure in these cases, start with timolol and the other agents.

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