Pediatric emergency medicine trisk 3688 3688

recommended when the diagnosis of traumatic iritis is suspected, as it is often
associated with other ocular injuries.

Management
Dilating drops and topical steroids are the mainstay of treatment for traumatic
iritis. Because of the risks associated with their use, these therapies should only
be prescribed in conjunction with ophthalmology consultation.

FIGURE 114.11 Retinal hemorrhages in abusive head injury. A: Retinal hemorrhages as seen
using the narrow view from a direct ophthalmoscope. B: Retinal hemorrhages as seen using a
wide-angle ophthalmoscope or retinal photography. (Reprinted with permission from Gold DH,
Weingeist TA. Color Atlas of the Eye in Systemic Disease . Baltimore, MD: Lippincott Williams
& Wilkins; 2001.)

Traumatic Versus Nonorganic Visual Loss
Occasionally, the emergency physician is faced with a child who is feigning
visual loss. Nonorganic visual loss can also be idiopathic and transient, or
associated with stress. A full ophthalmologic examination with visual acuity
testing, pupil function, visual fields, and anterior and posterior segment
evaluation is required before considering nonorganic vision loss. In the absence
of other signs of ocular or head trauma, this diagnosis should be considered. It
may become necessary to “trick” the child into demonstrating that he or she can
actually see. Patients who are truly acutely blind should demonstrate some degree
of anxiety and virtually complete inability to navigate in new surroundings. When
asked to write their names on a piece of paper, truly blind patients can do so
accurately, unlike children who are functionally blind who assume they are
unable to write. Children who are feigning visual loss but not complete blindness