- Normal visual acuity is 20/40 in a 3-year-old, 20/30 in a 4-year-old, and 20/20 in a 5- to 6-year-old child.
- Steroids should not be used for patients with iritis or keratitis until herpes simplex is excluded.
- Glaucoma should be suspected in patients who have eye pain and nausea and vomiting. Bilateral eye pressures should be checked immediately.
- Neonates with suspected gonococcal conjunctivitis should undergo a complete sepsis work-up, including a lumbar puncture. These patients should be admitted for intravenous antibiotics.
- Physical examination of patients with iritis reveals a miotic pupil, perilimbal injection, and an aqueous flare and cells on slit lamp examination.
- Chemical alkali burns to the eye can result in liquefactive necrosis and should be irrigated until the eye pH is between 6 and 8.
Children with eye disorders often come to the emergency department (ED). It is imperative that the emergency physician performs a complete eye examination in order to avoid overlooking potentially debilitating ophthalmologic injuries. The physician must remember certain important guidelines when facing patients with ocular disease.
- The cardinal rules of resuscitation are Airway, Breathing, and Circulation. In patients with multiple trauma or severe systemic disease, the life-threatening conditions must be evaluated and managed first. The eye must be protected from further damage. In patients with blunt head trauma, the mechanism of injury must be considered and treated appropriately. Problems should be anticipated ahead of time.
- A thorough and complete history must be taken. Have there been previous eye problems or surgeries? Are there underlying health problems? Does the patient wear glasses or contact lenses? If a traumatic injury has occurred, when and where did it occur? Who saw it? What type of instrument was involved? Who else was involved? What was done for the patient prior to arrival in the ED? In the absence of trauma, is eye pain present? Has there been eye discharge or exposure to others with similar conditions? Has there been use of systemic or topical medications?
- The visual acuity in both eyes must always be checked. Information about the unaffected eye can help guide one in the assessment of the affected eye.
- A general physical examination should be performed and rapport should be built with the child. Physicians should look for other underlying injuries or signs of systemic illness. The eye examination should be performed in a logical, methodical manner. Patients should be observed for any facial asymmetry. Toys or other objects that hold the interest of the child and allow proper evaluation of the visual fields should be used. The eye should be touched and dilated only after a thorough systemic examination, and only if indicated.
- If the possibility of a globe perforation exists, manipulation of the eye should not be performed. A metal shield should be used to protect the eye; a pressure patch is contraindicated. If there is concomitant head trauma, pupils should not be dilated.
- Physicians must know when to stop and when to ...
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