HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIESCOMPLICATIONS
■ Vision loss
■ Cavernous sinus thrombosis
■ CNS involvement
■ Abscess formation
■ Osteomyelitis
UNILATERAL VISION LOSSCan be divided into painless and painful types:
Painless: Painful:
Retinal detachment Glaucoma (acute angle closure)
CRAO Temporal arteritis
CRVO Optic neuritis
Vitreous hemorrhage Corneal ulcers, abrasions, FB
Amaurosis fugax
PAINFUL UNILATERAL VISION LOSSAcute Angle Closure Glaucoma
■ A cause of painful, acute vision loss
■ Occurs when the pupil dilates, triggered by dim light or mydriatics (tropi-
camide, cyclopentolate), leading to occlusion of trabecular meshwork →
preventing aqueous humor from exiting →increasing intraocular pressure
(IOP) (see Figure 14.38)
■ Risk factors: Hyperopia, large cataract, women, Eskimo/Asian ancestry
SYMPTOMS/EXAM
■ Severe, unilateral eye pain
■ Blurry vision classically with “halos” around lights
■ Headache
■ Steamy or hazy cornea
■ Injected red eye
■ Mid-dilated pupil, sluggish or nonreactive to light
■ Elevated IOP (40–70 mmHg) (see Figure 14.39)
■ Nausea and vomiting may misleadthe clinician.
TREATMENT
■ Block production of aqueous humor:
■ β-Blocker topical (eg, timolol) = nonselective BB reduces aqueous
humor production but is contraindicated in patients with COPD,
asthma, or congestive heart failure.
■ Alpha antagonist topical (brimonidine) = decreases aqueous humor pro-
duction and increases outflow.
■ Carbonic anhydrase inhibitors IV or PO (acetazolamide) = decrease aqueous
humor production, thus decreasing IOP; avoid in sulfur-allergic patients.
■ Reduce vitreous volume:
■ Osmotic agents
■ Glycerol
■ Mannitol
Open angle glaucoma
presents with painless,
gradual loss of peripheral
vision.