0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

SYMPTOMS/EXAM

■ Patients typically describe flashing lights and floaters, sometimes described

as “spider webs” or “coal dust.”

■ Visual field defects are a late symptom.

■ The retina appears like dunes on a beach or a curtain folded forward.

TREATMENT

■ Ophthalmology consultation

■ Urgency depends on visual acuity.

■ If the macula is still attached and acuity intact, surgical repair by a retina

specialist is recommended within 24–48 hours (to prevent macula from

detaching also).

■ If the vision is poor, the macula is likely already detached, and repair is

less urgent (within 5–7 days acceptable).

Lens Dislocation

May occur anteriorly or posteriorly (more common)

ETIOLOGY

■ Trauma (classically by air bag deployment)

■ Idiopathic

■ Marfan syndrome

SYMPTOMS/EXAM

■ Iridodonesis: Trembling iris after rapid eye movements

■ Monocular diplopia (two images seen with one eye)

TREATMENT

Urgent (not emergent) ophthalmology follow-up

COMPLICATIONS

Acute angle closure glaucoma

Central Retinal Artery Occlusion

ETIOLOGY

■ Atherosclerotic plaque embolizes to artery (eg, from internal carotid)

■ Hyperviscosity syndrome (multiple myeloma)

■ Trauma with fat embolus

■ Patients with sickle cell or DM

■ Temporal arteritis (5% of cases)

SYMPTOMS/EXAM

■ Sudden painless monocular vision loss

■ Afferent pupillary defect

■ Fundoscopy shows “box car” look to the retinal arterioles, a “cherry red

spot” after the first few hours; a pale disk is a much later sign (seen weeks

later). (See Figure 14.43.)