Pediatric emergency medicine trisk 0632 0632
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as ondansetron, antibiotics, pain medications, and sedation should be considered.
Retinal artery thrombosis is rare in children, but it should be suspected when
there is sudden, unilateral painless loss of vision, and a predisposing condition.
Predisposing conditions include those associated with emboli, such as endocardial
thrombi or amniotic fluid; conditions with arteritis leading to obstruction, as in
SLE; disease states associated with hypercoagulability, such as sickling
hemoglobinopathies; and conditions with arterial spasm, such as severe
hypertension.
If alkali burns, a ruptured globe, and retinal artery occlusion can be excluded,
the patient may be evaluated more carefully before instituting therapy. Significant
historical information includes episodes of recent trauma, unilateral or bilateral
nature of the loss, and association of pain in or around the eye ( Fig. 30.1 ). Most
children seen in the ED will have a traumatic or infectious process. Child abuse
may present with any of a variety of traumatic injuries. Retinal hemorrhages in a
child are almost always caused by nonaccidental trauma.
If hysterical blindness is suspected, the mirror test may be used. A mirror that
is large enough to prevent the patient from looking around is placed in front of
the patient’s face and is slowly rocked back and forth. The examiner should
observe the patient from above to see if the patient is able to suppress the
tendency to follow the mirror or hide a response to another visual stimulus, such
as a funny face made by the examiner.
FIGURE 30.1 Diagnostic approach to visual disturbances.
Severe Visual Loss Associated With Trauma
Severe bilateral visual loss associated with head trauma is likely cortical
blindness. This condition usually is totally reversible in less than a few hours.
Any of the traumatic injuries that cause severe unilateral loss of vision may cause
bilateral loss if both eyes are involved. If there is any possibility of a penetrating
