- A history of exposure to power tools or metal striking metal should raise the suspicion of an intraocular foreign body.
- Children with sickle cell disease or coagulopathy are more likely to suffer complications associated with a hyphema.
- Visual acuity is the vital sign of the eye and should be documented in every child with an ocular injury or visual complaint.
- Be concerned about the appearance of a corneal abrasion in the absence of known trauma as this may represent herpetic dendrites rather than corneal abrasions.
- Obtain an ophthalmology consultation in the emergency department on all patients with hyphemas, suspected globe rupture, or significant visual impairment.
- A caustic injury to the eye (acid or alkali) is one of the few situations in which treatment must occur prior to examination and visual acuity testing. Copious irrigation with normal saline takes precedence over all but lifesaving interventions and should begin at the time and site of exposure.
Ocular trauma is the leading cause of noncongenital blindness in individuals younger than 20 years. Every year in the United States approximately 840 000 children injure an eye with an estimated cost of more than $88 million. Motor vehicle crashes account for the majority of hospitalized eye injuries. Recreational and sports injuries are more prevalent in the pediatric population than they are in adults. In addition, ocular trauma may occur as a consequence of child abuse. In preschool children, most injuries are due to falls, motor vehicle collisions, and accidental blows to the eye. In adolescents and teenagers, ocular trauma occurs twice as often in male patients.1 This is also the age group in which sports-related injuries become an important factor, especially baseball, ice hockey, racquet sports, soccer, archery, and fishing injuries.2 Fireworks and gun-related eye injuries have decreased in incidence in the last 10 years but remain significant causes of pediatric eye injury.3,4
Obtain a full history and note any preexisting eye abnormality and whether or not the child normally wears glasses or contacts. A history of exposure to power tools or metal striking metal should raise the suspicion of an intraocular foreign body. Inquire as to whether the child is having double vision. If so, determine whether the diplopia is monocular or binocular. Monocular double vision implies a problem with the lens or retina, whereas double vision that occurs only with both eyes open is associated with periorbital fractures, extraocular muscle injury, or palsy.
Past medical history is also important. Children with sickle cell disease or coagulopathy are more likely to suffer complications associated with a hyphema. Children with osteogenisis imperfecta have fragile sclera and are more prone to open globe injuries from trauma.5
The physical examination of the eye should be performed early in the emergency department (ED) course, after any life-threatening injuries have been excluded or addressed. Progressive lid edema can prevent an adequate examination of the eye.