CC = R eye pain

History

• A 34 year woman complaints of R eye pain after being punched directly in the face several hours prior to arrival
• She is complaining of pain and blurred vision as well as light sensitivity
• She denies any LOC or amnesia, and has no other pain complaints

Exam

• +periorbital swelling around the R eye
• 3 cm linear laceration 3 cm below R lower lid
• R pupil is 4 mm, slightly irregular, and has no response to direct light or consensual reflex
• There is no increased pain in the R eye when light is shined in the L eye (no pain with consensual light reflex)
• IOP is 6 mm Hg OD and 7 mm Hg OS
• Slit lamp exam shows no hyphema, +fluorescin uptake at 7 oclock over <10% of the cornea

Diagnosis and Management

• Patient's mydriatic and poorly contractile pupil is due to traumatic mydriasis
• The scalloped, irregular margins of the iris are due to concomitant tears in the iris sphincter

• Treatment of corneal abrasions involves topical antibiotics such as ciprofloxacin drops or erythromycin ointment as well as pain control
• Treatment of traumatic mydriasis involves topical cycloplegics to relieve concomitant ciliary spasm and opthalmology followup
• Opthalmology may treat with surgery if the mydriasis fails to resolve on its own
• Watch a short clip of this very disturbing surgery here

Pearls

• Opthalmology followup is key
• Be sure to assess for vision threatening concomitant injuries such as globe rupture, traumatic hyphema, and retrobulbar hematoma with increased IOP