The authors describe a 78-year-old woman who suffered a traumatic partial de hiscence of a penetrating keratoplasty on the day prior to presentation. While a waiting surgical repair, the patient experienced an expulsive choroidal hemorrha ge necessitating a primary evisceration of the eye. This case is unique because the hemorrhage can be largely attributed to the acute dramatic rise in systemic blood pressure that immediately preceded it. Management considerations for patie nts with open-globe injuries who have poorly controlled systemic hypertension s hould include closemonitoring of vital signs in a controlled setting, anxiolysis , aggressive intervention for hypertensive lability, and hastening of surgical r epair regardless of nothing by mouth status. The authors describe a 78-year-old woman who suffered a traumatic partial de hiscence of a penetrating keratoplasty on the day prior to presentation. The patient experienced an expulsive choroidal hemorrha ge necessitating a primary evisceration of the eye. This case is unique because the hemorrhage can be largely becausetributed to the sharp onset rise in systemic blood pressure that before preceded it. Management considerations for patie nts with open-globe injuries who have poorly controlled systemic vital can in close controlled setting, anxiolysis, aggressive intervention for hypertensive lability, and hastening of surgical r epair regardless of nothing by mouth status.