Ocular trauma is a frequent presenting complaint and a major
cause of ocular morbidity and unilateral blindness in children.
The magnitude of serious eye injuries in children has been estimated
at 11.8 per 100,000 per year.1 Children in the
11-to-15-year age group have a higher incidence of trauma compared
to other age groups. Boys outnumber girls approximately 3 or 4 to
Ocular injuries require prompt evaluation and care in order to
preserve vision. Evaluation of the injury is more difficult due
to decreased cooperation and understanding in children. The injured
patient is frequently young, afraid, in pain, and able to provide
only limited compliance. The examination should be as complete as
the injury permits; forcible evaluation may risk further damage.
Topical anesthesia, local anesthesia, and sedation are all useful
for assessing and treating minor trauma. If the pediatrician or
emergency room physician cannot perform an adequate examination,
or as soon as there is concern for significant ocular damage, the
injured eye should be covered with a protective shield (not patched)
and ophthalmology consultation should be obtained. It is also important
to recognize that managing the eye injury always takes a lower priority
than managing life-threatening injuries and serious head trauma.
The injured eye can be shielded while emergency procedures are under
way to stabilize the child systemically. Yet, with the exception
of the uncommon vasovagal response induced by eye examination, the
ophthalmologist can conduct a limited brief assessment that will be
relatively noninvasive and may offer helpful management guidelines.
While that examination is pending, the eye should be shielded (not patched).
Assessment of visual acuity in both eyes is important for predicting
the final visual outcome and for medicolegal purposes. It can also
help in assessing the cause for visual loss. For example, if a child
develops a swollen eye after being punched at school and the vision
in that eye is 20/100 but the eyeball is otherwise apparently
normal, it would be reassuring to know that the other eye (not injured)
also sees poorly, indicating the child may simply need glasses for
nearsightedness. Techniques for assessing vision, opening the eye,
and examining the eyeball have been discussed in Chapter 580.
Amblyopia frequently results from ocular trauma. Extended observation
and treatment for optimal vision development are often needed once
the initial injuries have been managed.
Corneal abrasion is one of the most frequent ocular injuries
of childhood. The abrasion results from mechanical removal of the
superficial epithelial layers of the cornea. This can cause intense
pain, protective spasm closure of the lids, tearing, and photophobia,
although some children may be surprisingly asymptomatic. Examination
is facilitated by a drop of topical anesthetic followed by fluorescein
dye. The dye is available as a liquid mixed with anesthetic or in
dry impregnated strips. The latter tends to be more effective in
diagnosis, as it allows only a small amount of dye to be placed. ...