0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

■ Decreased vision
■ Afferent pupillary defect
■ Tenderness with palpation of the temporal region
■ Elevated ESR, CRP
■ Disk pallor due to decreased blood flow in the retinal artery (uncommon
but significant cause of CRAO)

TREATMENT

■ High-dose steroids (start if clinical suspicion high)
■ Admit if severe symptoms or eye involvement for IV steroids and consult
ophthalmology.
■ Diagnosis should be confirmed with a temporal artery biopsy (performed
by ophthalmologist or vascular surgeon). As distribution is segmental or
patchy, multiple biopsies may be needed.

COMPLICATIONS

If diagnosis is missed, can lead to bilateral blindness.

PAINLESS UNILATERAL VISION LOSS

Retinal Detachment

Tear in the retina allowing the vitreous fluid to separate the neurosensory
retina from the pigmented epithelium underneath (see Figure 14.42)

ETIOLOGY

■ Spontaneous retinal detachment associated with nearsightedness, family
history, prior cataract surgery, retinopathy (diabetes, sickle cell disease)
■ Also caused by trauma.

ESR is typically elevated with

temporal arteritis. ESR

increases with age, with the

normal upper limit estimated

by

Men: Age divided by 2 and

Women: (Age + 10) divided

by 2.

FIGURE 14.42. Retinal detachment from 11 o’clock to 4 o’clock. Note the dunes on a
beach appearance. (See also color insert.)

(Reproduced, with permission, from Kasper DL, Braunwald E, Fauci AS, et al. Harrison’s
Principles of Internal Medicine, 16th ed. New York: McGraw-Hill, 2005:170.)