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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 1.2

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. ...

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