“You’re going to shoot your eye out!” Common ocular trauma in children Desinee Drakulich OD

Disclaimer I have no affiliation, nor do I received financial compensation from any of the companies or brands used in this presentation.

Two Studies Eye injuries in children: the current picture (Europe, 1998) Pediatric Eye Injury - Related Hospitalizations in the United States (2000)

Current Picture Eye Injuries in children (MacEwen) 415 patients Leading cause of non-congenital unilateral blindness in children years old.

Common Dangers Sports balls Darts BB guns Projectile toys Broken toys Finger/fist Pencils/Scissors Rubber bands

Mechanism of Injury

Place of Injury

Cause of Injury

Final Visual Acuity

Pediatric Eye Injury 3834 eye injuries evaluated from 7527 eye injuries reported in patients under 20 y.o. Estimated 2.4 million eye injuries/year 35% of injuries are patient under 17 y.o. Average cost per year - 88 million Leading cause of monocular visual disability and non-congenital unilateral blindness in children.

Age & Gender

Mechanism of Injury

Cause of Injury

Clinical Symptoms Pain Watery discharge Double Vision Decreased Vision Sharp, sectoral, dull, photophobic Entrapment, Nerve damage, Hemorrhage Damage, Hemorrhage

Clinical Signs Acuity EOMs Lids Globe Conjunctiva Cornea Anterior chamber Anterior Uveitis Hyphema Iris Lens Vitreous Retina Choroid Optic Nerve Avulsion

Lids

Signs  Ecchymosis, swelling, lacerations Treatment  Suture Oral Antibiotic  Dicloxacillin 250 mg QID, 5-7 days Topical Antibiotic  Polytrim, Bacitricin  Ice 48 hrs  Warm 5-7 days

Orbit

Signs  Blow-out fracture  Orbital prolapse  Diplopia (vertical)  EOM entrapment  Crepitus Treatment  Orbital CT  Surgical Consult  Avoid blowing nose  Nasal decongstant Afrin BID, 10 days  Ice 48 hrs  Oral Antibiotics Augmentin 250 mg po TID, 10 days

Globe

Full thickness lacerations/Intraocular Foreign Bodies  Aching Pain  Photophobia  Decreased VA  Diplopia  Chemosis  Cell/Flare  High or Low IOP Treatment  Advise patient to consume NO food or water.  Shield eye  Transport to nearest ocular surgeon Seidel may be checked in office.

Conjunctiva

Laceration  Hemorrhage  Direct observation of sclera Treatment  Antibiotic ointment Tobramycin, Polymyxin B  Cycloplegia Homatropine 5%  Pressure patch 24 hrs  Monitor for infection

Conjunctiva

Subconjunctival Hemorrhage  Red eye  Usually no visually distrubance  Usually no pain Treatment  Patient Reassurance  Artifical Tears

Cornea

Partial Thickness Laceration  Pain  Decreased VA  Photophobia  Increased tearing Treatment  Same as conjunctival laceration  Tight fitting bandage CL  Fluoroquinolone  Cycloplegic  Oral analgesic

Cornea

Abrasion  Pain  FBS  Tearing  Photophobia  NaFl staining  Mild AC reaction Treatment  Cycloplegic QID  Zymar QID  Bandage CL  Topical NSAID  Oral Analgesic

Traumatic Uveitis

Signs/Symptoms  Pain  Photophobia  Tearing  Decreased VA  Cells/Flare  Iridodialysis Treatment  Subclinical Cycloplegic  Grade 1, 2 Cycloplegics QID Pred Forte 1%, QID  Grade 3, 4 Cycloplegics Pred Forte q5min - q2h B-blocker (timolol)

Hyphema

Microhyphema  Bedrest  Head Elevation  Avoid NSAIDs/Aspirin  Protective shield  Pred Forte 1% QID  Cycloplegic  Monitor IOP Severe Hyphema  Hospitalization - especially young children  Antifibrinolytic agent Aminocaproic Acid (50 mg/kg q4h)  Risk of amblyopia in young children

Lens

Subluxation  Increased IOP  Pain  Decreased VA  Diplopia Treatment  Cyloplegic  B-blocker or oral pressure lowering or agent  Refer for repositioning or removal

Lens

Traumatic Cataract  Reduced VA  Diplopia  Elevated IOP  Stellate or Rosette opacity  Vossius Ring Treatment  B-blocker  CE/PC IOL

Vitreous

PVD  Block Spot or Weiss Ring Traumatic Hemorrhage  Reduced VA  Cloudy or curtained vision Treatment  Monitor Treatment  Sleep with head elevated  Avoid NSAIDs/ Aspirin  Vitrectomy

Retina

Detachment Traumatic Macular Hole Commotio Retinae Refer to Retinal Specialist Vitrectomy with peeling of cortical vitreous Monitor

Choroid

Choroidal Rupture Signs/Symptoms  Reduced VA  Metamorphopsia  Similar to RD Treatment  No specific Tx  Monitor for CNVM  Refer to Retinal Specialist for FA

Optic Nerve

Traumatic Optic Neuropathy  Relatively Rare  Nerve appears normal  Functional defect Decreased VA APD Color defect Visual Field defect Treatment  Refer  IV steroids  Surgical decompression  No Tx for avulsion

Conclusion Accidental eye injuries are the leading cause of monocular visual disability and non-congenital unilateral blindness in children. 90% of eye injuries could have been prevented or decreased in severity with better education, appropriate use of safety eyewear, and removal of common and dangerous risk factors.

References Brophy M, Sinclair S, Hostetler G and Xiang H. Pediatric Eye Injury-Related Hospitalizations in the United States. Pediatrics 2006;117; MacEwen C, Baines P and Desai P. Eye injuries in children: the current picture. Br. J. Ophthalmol. 1999;83; Mulrooney B. Cataract, Traumatic. E-medicine.com Onofrey B, Skorin L, Holdeman N. Ocular Therapeutics Handbook: A Clinical Manual. Second Edition 2005.