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Anisocoria in a pediatric patient after bounce house accident
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The ophthalmology service at Tufts Medical Center was consulted for a “blown pupil” in the right eye of a 2-year-old boy. He was admitted to the pediatric intensive care unit after falling approximately 15 feet from an unsecured bounce house that was lifted into the air by a gust of wind.
When emergency medical services arrived, the patient was found lying on his back, minimally responsive with a weak cry and shallow breathing. He was intubated in the field, and atropine was used before intubation. The dilated right pupil was noted by EMS before arrival at the hospital, but the timing of the onset of the dilated pupil was unclear.
Examination
The initial ophthalmologic examination was limited because the patient was sedated and intubated. The right pupil was 7.5 mm, round and unreactive to light. The left pupil was 3 mm, round and reactive to light, constricting to 1 mm. There was no relative afferent pupillary defect. Alignment appeared orthophoric. Extraocular motility by vestibulo-ocular reflex could not be assessed because there was a cervical collar in place. There was no periorbital ecchymosis, swelling or laceration. Portable slit lamp exam of the anterior segment revealed no evidence of uveitis or hyphema. The dilated fundus exam was normal with no optic nerve head edema.
Click here to read the publication exclusive, Grand Rounds at the New England Eye Center, published in Ocular Surgery News U.S. Edition, January 25, 2015.