Eye Injury: Anisocoria Due to Blunt Trauma
Air bags save many lives. They are also the cause of many injuries – including permanent disfigurement to the eyes. There are three main types of injury from the extreme force of the air bag explosion:
- concussion – which is a form of brain damage
- tinnitus – ringing in the ears
- anisocoria – difference in pupil sizes
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Suffering a blunt trauma to the head or eye area may tear the pupil sphincter causing a permanently dilated pupil, termed anisocoria. This condition has become more prevalent since air bags have become standard features in motor vehicles. Initially, anisocoria may present as retina damage or even sudden vision loss. The vision usually returns completely within 4-6 weeks, leaving the disfiguring dilated pupil.
After blunt force trauma to the head, as in an air bag deployment which can snap the head back, you should have a neurological examination. The exam should include checking the corneal reflex and manual palpation of the eyeball. A cranial computed tomography (CT) scan is also helpful in diagnosing the extent of the injury.
There have been cases where there were no symptoms or signs of spinal or brain injury, where the patients have had a Glasgow Coma score of 13-15 (where a 3 is severely brain damaged and 15 is very mild brain damage), but then during neurological examinations anisocoria was discovered. At this point an MRI needs to be done on the patient. It will usually show more damage than was originally diagnosed — possibly a spinal cord compression or spinal cord contusion requiring surgery.
Because of these cases, it highlights the need for strict observance of Advanced Trauma Life Support guidelines. Where spinal or brain injury is suspected, it requires a thorough examination of the central and peripheral nervous system. This is necessary even in cases where the injuries seem minor and there is an absence of radiographic abnormality and neck pain. Failure to do so can have dire consequences.
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