Pediatric emergency medicine trisk 0625 0625
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Trauma can also cause a hyphema or hemorrhage into the anterior chamber.
The degree of visual impairment in the affected eye ranges from little to severe,
depending on the extent of bleeding and associated trauma. Complications of
hyphema include rebleeding, which typically occurs within the first 5 days after
injury, and increased intraocular pressure potentially leading to glaucoma.
Previously, all patients with hyphema were hospitalized on strict bed rest.
However, this was not shown to improve outcome, but close follow-up with an
ophthalmologist is recommended. Despite lack of definitive evidence, most
ophthalmologists recommend cycloplegic and corticosteroid drops to reduce pain
and possibly reduce inflammatory complications. Nonsteroidal anti-inflammatory
drugs (NSAIDs) should be avoided. The risk of vision loss is highest in patients
with sickle cell disease or trait, when greater than 20% of the visual field is
affected, with rebleeding, and when residual blood lasts beyond 3 to 4 days
duration.
Traumatic injuries can lead to cataract formation, usually within a few days of
injury, but onset may be delayed for years. Dislocation of the lens after trauma
causes significant visual impairment but can be recognized easily with a careful
examination. Glaucoma and retinal detachment may be late complications of
blunt trauma. Pain around the eye, blurred vision, and occasionally, nausea and
vomiting in a patient with glaucoma or with a recent eye injury may represent an
acute attack of glaucoma. If any one of these is noted as a primary complaint or
an incidental finding, immediate referral is required.
TABLE 30.2
COMMON CONDITIONS THAT CAUSE ACUTE VISUAL
DISTURBANCES
Trauma
Migraine
Chemical burns
Hyphema
Ruptured globe
Periorbital infection
Conjunctivitis
The uvea consists of the iris, ciliary body, and choroid. One or all portions of
the uvea may become inflamed, causing uveitis. Iritis and iridocyclitis may be
