Traumatic mydriasis
Background
- Occurs due to small tears in the ciliary muscles
- No specific ED management, but requires ophthalmology follow up
- Diagnosis of exclusion!
Clinical Features
- Pupillary dilation due to blunt eye trauma
- Pupil is poorly reactive to light in both direct and consensual light exposure
- May be transient or permanent
Differential Diagnosis
- Physiological Anisocoria
- Intracranial Injury
- Congenital eye defects
- Drugs and toxins
- Third nerve palsy
- Pharmacologic mydriasis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Clinical; rule out intracranial injury
Management
- No specific ED management
Disposition
- If no other injuries/pathology, discharge with optho follow up
External Links
References
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