Approximately one-third of the estimated 2.4 million eye injuries that occur annually in the United States are in people age 17 and younger. Males make up three-quarters of reported eye injuries, and about one-half of eye injuries occur in the home. A history determining the mechanism of injury can help guide your examination and decision about referral.
Assess the vision in each eye, if possible. Subtle differences in vision may be related to poor cooperation, but relative visual acuity difference should prompt referral to the ophthalmologist. Careful examination of the eye and adnexa can be conducted using a handheld light looking for a laceration involving the eye, the eyelid margin or the tearduct system.
Subconjunctival hemorrhage is common and generally can be managed with lubrication (artificial tears or ointments). Placing fluorescein in the injured eye will stain areas of epithelial abrasion, whether of the conjunctiva or the cornea. Use antibiotic drops or ointments until the corneal/conjunctival abrasion has healed to prevent secondary infection. It’s better to avoid using steroid drops, even if in combination with antibiotic drops. If the eye becomes more painful, or if there is a "white" area adjacent to the abrasion, the cornea may be infected and the patient should be urgently referred. A persistently red eye may indicate greater trauma than initially appreciated by history and examination.
Assessing the eye for signs of more extensive trauma should include careful assessment of the pupil. Any asymmetry to the shape or size of the pupil may herald more significant injury to the eye, including a ruptured globe. Sluggish pupils, pain or significant photophobia associated with shining a light in the eyes could indicate traumatic iritis. Any significant trauma can result in retinal detachment, which can be described by a patient as floaters, flashes of lights, a curtain over the vision or loss of vision.
Prevention is best, and eye protection, especially sports goggles, should be encouraged for activities. If the history or examination is at all concerning, we are glad to perform a complete ophthalmologic exam.
—Danielle Ledoux, MD, ophthalmologist
More information: 617-355-6401 or childrenshospital.org/eyes