Critical Cases - Traumatic mydriasis!

CC = R eye pain



  • 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


  • +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