Anisocoria in a pediatric patient after bounce house accident

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.