Pediatric emergency medicine trisk 0578 0578
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the conjunctiva must be inspected. The upper eyelid should be everted (see
Chapter 114 Ocular Trauma ). The lower eyelid should be pulled down from the
globe as the patient looks upward so the inferior fornix can be inspected. The
patient should be asked to adduct the affected eye when the lateral canthus is
stretched laterally to allow inspection of the lateral fornix. There is no analogous
medial fornix. In addition to direct trauma, head injury can rarely cause the
development of an intracranial arteriovenous fistula that may present with
proptosis, chemosis, red eye, corkscrew conjunctival blood vessels, and decreased
vision.
TABLE 27.2
LIFE-THREATENING CAUSES OF RED EYE a
Systemic disease (Table 27.3 )
Child abuse
Blunt trauma
Covert instillation of noxious substances (medical child abuse [Munchausen
syndrome by proxy])
Traumatic intracranial arteriovenous fistula (very rare)
a List
not meant to be complete.
