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Information

Symptoms

Dull, aching, or throbbing pain, photophobia, tearing, redness, blurry vision, occasionally floaters, and onset of symptoms usually within 1 to 3 days of trauma.

Signs

Critical

White blood cells (WBCs) and flare in the AC (seen under high-power magnification by focusing into the AC with a small, bright, tangential beam from the slit lamp).

Other

Pain in the traumatized eye when light enters either eye (consensual photophobia); lower (due to ciliary body shock/shutdown) or higher (due to inflammatory debris and/or trabeculitis) IOP than fellow eye; smaller, poorly dilating pupil or larger pupil (often due to iris sphincter tears) in the traumatized eye; perilimbal conjunctival  injection; keratic precipitates (diffuse or inferior cornea); Vossius ring (ring-shaped iris pigment deposits on the anterior lens capsule surface due to blunt trauma driving the iris posteriorly); decreased vision.

Differential Diagnosis

Workup

Complete ophthalmic examination, including IOP measurement and dilated fundus examination.

Treatment

Cycloplegic agent (e.g., cyclopentolate 1% or 2% b.i.d. to t.i.d.). May use a steroid drop (e.g., prednisolone acetate 0.125% to 1% q.i.d.). Cautious use of topical steroids if an epithelial defect is present. A topical beta-blocker (e.g., timolol or levobunolol 0.5% b.i.d.) may be considered if the IOP is elevated.

Follow-Up

  1. Recheck in 5 to 7 days.

  2. If resolved, discontinue the cycloplegic agent and taper steroid drops if using.

  3. Around 1 month after trauma, perform gonioscopy to look for angle recession and indirect ophthalmoscopy with scleral depression to detect retinal breaks or detachment.