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

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

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

5. Current Picture Eye Injuries in children (MacEwen) 415 patients Leading cause of non-congenital unilateral blindness in children 0 - 14 years old.

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

7. Mechanism of Injury

8. Place of Injury

9. Cause of Injury

10. Final Visual Acuity

11. 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.

12. Age & Gender

13. Mechanism of Injury

14. Cause of Injury

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

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

18. Lids

19. 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

20. Orbit

21. 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

22. Globe

23. 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.

24. Conjunctiva

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

26. Conjunctiva

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

28. Cornea

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

30. Cornea

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

32. Traumatic Uveitis

33. 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)

34. Hyphema

35. 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

36. Lens

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

38. Lens

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

40. Vitreous

41. 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

42. Retina

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

44. Choroid

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

46. Optic Nerve

47. 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

48. 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.

49. References Brophy M, Sinclair S, Hostetler G and Xiang H. Pediatric Eye Injury-Related Hospitalizations in the United States. Pediatrics 2006;117;1263-1271. MacEwen C, Baines P and Desai P. Eye injuries in children: the current picture. Br. J. Ophthalmol. 1999;83;933-936. Mulrooney B. Cataract, Traumatic. E-medicine.com. 2006. Onofrey B, Skorin L, Holdeman N. Ocular Therapeutics Handbook: A Clinical Manual. Second Edition 2005.