PEDIATRICS EYE INJURY
Objectives
At the end of the session, the students will
be able to;
• Define eye injury
• Identify causes and risk factors of eye injury
• Classification of eye injury
• Identify sign and symptoms of eye injury
• Identify diagnostic method of eye injury
• Differential diagnosis of eye injury
• Explain management of eye injury
• Identify complications of eye injury
• Identify prevention of eye injury
Eye injury
• Eye injury is any trauma/damages to the
eyeball, eyelid or bones around the eye.
• It is the most common preventable cause of
childhood blindness.
• It can be unilateral or bilateral
• A painful eye injury or blurred vision can be a
sserious eye injury.
• Eye trauma in children accounts for 7% of all
physical injuries and 10% - 15% of all eye
diseases
Eye injury…
Causes of eye injuries
• Eye injuries from sports are quite common.
Hockey
Archery
Darts
BB guns
Bicycling
Jumping
Baseball
Boxing
Basketball
Causes…
The most common causes are:
• Misuse of toys
• Falls down accident
• Misuse of everyday tools and objects
• Contact with harmful household
products (detergents, Chemicals, paints,
glues, etc).
• Automobile accidents
• Prolonged light exposure
Types of eye injuries
Corneal Abrasions:
• A corneal abrasion is a scratch or injury to
the cornea.
• This is a very common occurrence in
children.
Chemical burns:
• It occurs when the child gets any type of
chemical in his or her eye.
• It is due to acids, alkalis, rubbing the
eye, aerosol exposure.
Types…
Subconjunctival;
• Bleeding a collection of blood lying on
the surface of the white of the eye
(sclera).
Types …
Hyphema:
• It is defined as hemorrhage into the anterior
chamber.
Types…
Eyelid lacerations:
• Eyelid lacerations are cuts to the eyelid
caused by injury.
• It is common in young children
• These injuries commonly occur from
sharp objects but can also occur from
a fall.
Types…
Bruising or Black Eye (Ecchymosis):
• Ecchymosis, more commonly known
as a "black eye,“.
Fractures of the orbit:
• When one or more bones surrounding
the eye are broken, the condition is
called orbital fracture.
Types…
Traumatic iritis:
• Often a result of a blunt blow to the
eye.
Types …
Foreign bodies in the eye:
• Generally, a foreign body is a small piece
of metal, wood, or plastic in the eye.
Radiation burns;
• Radiation burns in the form of
ultraviolet light from the sun, sun
lamps, snow reflectors (snow
blindness).
Types…
Birth Injuries;
• Mechanical trauma to the eyes and
eyelids can occur at the time of birth
• Particularly if labor is prolonged and
difficult or if instrumentation is used.
• The most common ocular birth injury
is retinal hemorrhage.
Sign and symptoms
General symptoms include:
• Blood in the eyeball
• Changes in the shape/size of the iris or pupil
• Eye pain
• Cuts to the eyelid
• One eye is not moving as well
• Pain
• Redness and watering
• A sensation that something is in the eye.
• Blurred vision
• Light sensitivity
Diagnostic methods
• History and physical examination
Visual acuity test and other tests
• Clinical features
• Diagnostic investigations:
CT scan of head and orbit
Plain x-ray
B-scan ultrasonography
Ultrasound bio microscopy
Fluorescein angiography
MRI scan of head
Differential diagnosis
• Bacterial endophthalmitis
• Fungal endophthalmitis
• Bacteria keratitis
• Corneal foreign body
• Scleritis
• Fungal karatis
• HSV karatis
Management
First aid:
• Do not touch, rub or apply pressure to the eye
• Do not try to remove any object stuck in the eye
• Do not apply ointment or medication to the eye
• A cut or puncture wound should be gently
covered
• Only in the event of chemical exposure, flush
with plenty of water
Management…
• Pad the eye for 4 hours to prevent accidental
further eye injury
• Apply cold compressed intermittently 5 -10.
• Antipain (Paracetamol).
• Not aspirin or Ibuprofen which may increase
bleeding.
Management…
For chemical exposure;
• Removing all particulate debris
• Flush the eye (see routine irritation) for 15 -30
minutes with warm water
• Pain relief medication
• Topical antibiotics to reduce the risk of
infection
• Medication eye drops
• Lubricants applied to the eye surface to
prevent the eyelids from sticking to the
cornea as it heals
Management…
Medical management for all types;
• Chloramphenicol ointment/drops
• Cycloplegic eye drops
• Corticosteroids
• Cyclopentolate 1%
• Homatropine 2% to relief very sever pain
Management…
Corneal Abrasions;
• A topical anesthetic facilitates examination.
• Broad-spectrum antibiotic ointment, a
short-acting Cycloplegic drop
• Applying a firm pressure patch for 24
hours.
Management con’t…
HYPHEMA;
• A topical and systemic corticosteroid like
prednisolone, Cycloplegic if iritis develops.
• Prophylactic use of an antifibrinolytic agent
such as aminocaproic acid (Amicar) in the
dosage of 50 to 100 mg/kg body weight up to
30 g/d orally for 5 days.
• These drugs reduce lysis of the initial clot
until the ruptured blood vessels heal.
• And facilitate clearance of hyphema when
used at the right time.
Management con’t…
• Foreign bodies of the conjunctiva can
usually be removed by flushing the eye
with a stream of isotonic saline or eye
wash or by using a moistened cotton-tip
applicator.
• Broad-spectrum topical antibiotics
should be used after the foreign body is
removed.
Management…
Complication
• Infection
• Recurring eye injury
• Corneal scaring
• Iridodialysis
• Post traumatic glaucoma
• Uveitis cataract
• Retinal detachment
Prevent children eye injuries
• Wash child’s hands after using household
chemicals; household products
• Wear chemical safety goggles
• Don’t mix cleaning agents around or near
your child.
• Turn spray nozzles away from child’s face
• Don’t open bottle tops (such as wine or
carbonated beverages) near the child.
Prevention…
• Playing games and operating equipment
should be safe and with directions
• Provide lights to improve safety
• Keep paints, pesticides and fertilizers
properly
• Protect child’s eyes from the sun, either by
wearing a wind-brimmed hat or ultraviolet
(UV)-protective sunglasses
Prevention…
• Instruct the child to never look directly at
the sun
• Wear recommended protective eyewear
during the appropriate sports and
recreational activities.
• Wear a helmet with a polycarbonate face
mask or wire shield during the appropriate
sports
• Wear protective eye wear when performing
science or lab experiments at school.
