Traumatic mydriasis

Background

• Pupillary dilation due to blunt eye trauma
  • Pupil is poorly reactive to light in both direct and consensual light exposure
• Occurs due to small tears in the ciliary muscles
• May be transient or permanent
• No specific ED management, but requires ophthalmology follow up
• Diagnosis of exclusion!

Differential Diagnosis

• Physiological Anisocoria
• Intracranial Injury
• Congenital eye defects
• Drugs and toxins
• Third nerve palsy
• Pharmacologic mydriasis
• Injuries associated with blunt eye trauma
  • Conjunctival hemorrhage
  • Corneal abrasion, Corneal laceration
  • Globe rupture
  • Retrobulbar hematoma
    • Ocular compartment syndrome
  • Traumatic iritis
  • Lens dislocation
  • Retinal detachment
  • Vitreous detachment
  • Vitreous hemorrhage

Evaluation

• Clinical; rule out intracranial injury

Management

• No specific ED management

Disposition

• If no other injuries/pathology, discharge with optho follow up