3-22
or viral infection.
Follow-Up: Return if dizziness persists beyond 7-10 days, or if symptoms worsen or if alteration of hearing
is noted.
Evacuation/Consultation Criteria: Evacuate patients with persistent or recurrent symptoms of vertigo or
dizziness, especially if there is an alteration of hearing, for neurological evaluation.
Symptoms: ENT Problems
To be published. Other references to ENT problems in this edition are in:
Symptom: Cough; Fever
Respiratory: Common Cold and Flu; Asthma
Dental Surgery: Herpetic Lesions; Aphthous Ulcer; Oral Candidiasis
Infectious Disease: Adenovirus; Infectious Mononucleosis; Streptococcal Infections
Dive Medicine: Barotrauma, Ears; Barotrauma, Other
Aerospace Medicine: Barosinusitis; Barotitis
Symptoms: Eye Problems:
Acute Vision Loss without Trauma
MAJ Thomas Lovas, MC, USA & CAPT Frank Butler, MC, USNIntroduction: Many disorders may cause acute visual loss in a non-inflamed eye: retinal detachment, anterior
ischemic optic neuropathy, optic neuritis, central retinal vein occlusion, anterior ischemic optic neuropathy,
vitreous hemorrhage, significant high-altitude retinal hemorrhage, giant cell arteritis and central retinal artery
occlusion. These disorders are difficult to diagnose and treat while deployed. In most cases all that can be
done is to arrange for an expedited evacuation. Giant cell arteritis (GCA) and central retinal artery occlusion
(CRAO) can be treated in the field. Vision loss in one eye due to giant cell arteritis is often rapidly followed
by loss in the other eye if untreated. In addition, giant cell arteritis has a significant mortality. If vision loss is
associated with trauma, see Eye Injury section.
Subjective: Symptoms
Sudden versus gradual loss of vision, eye pain, seeing bright spots, fever, headache, foreign-body sensation,
increased sensitivity to light or photophobia (from irritation of cornea or iris), dry eye, jaw pain.
Focused History: Quantity: Have you lost your central or peripheral vision or noticed a blind spot? (A blind
spot in the field of vision represents an area that is not receiving visual information due to disease.) Quality:
Has the sharpness of your vision decreased? (may indicate an optic nerve disease such as optic neuritis)
Do you have pain in or behind your eye? (Deep, dull ache in or behind the eye is most often due to uveitis,
glaucoma, scleritis or other inflammatory processes affecting the anterior segment.) Do you feel you have
something in your eye? (Foreign body sensation is due to irritation or trauma of the cornea or conjunctival
epithelium.) Duration: Did you have sudden or gradual loss of vision? (gradual decreases in vision typically
indicate a non-emergent process such as cataract or diabetic retinopathy) Alleviating or Aggravating
Factors: What makes your vision better? (Improvement with rapid blinking suggests a tear abnormality such
as dry eyes; improvement with squinting suggests a refractive problem.)
Pearl: Scotomas (blind spots) noticed by the patient are usually due to retinal hemorrhage, edema, or
detachment, or due to optic nerve dysfunction (e.g., optic neuritis or optic neuropathies).
Objective: Signs
Partial or total loss of vision, fever, jaw tenderness, conjunctivitis, photophobia
Using Basic Tools: Inspect extraocular muscles. Have patient look in all directions and note any limitations
that may indicate entrapment of a muscle, orbital fracture or palsy.
Flashlight: Look for possible residual metallic foreign body