Pediatric Ocular Trauma

Penetrating trauma is the result of an object such as a pencil, stick or projectile entering the eye itself.

Chemical trauma

Chemical trauma can happen when harsh liquids such as household cleaners or chlorine damage a child's eye.

Several eye injuries can threaten your child's vision and need immediate treatment. These include:

• A foreign body in the eyeball or cornea
• A ruptured globe (usually from fireworks or explosives)
• Burns on the cornea (most often from chemicals)
• Blood in the anterior chamber of the eye (hyphema)
• Detached retina
• Infections on the cornea (from contact lenses)

If your child has had an eye trauma, first determine the cause. Blunt traumas may not need treatment, while perforations or chemical injuries often require immediate care. If your child is complaining of pain or vision problems following an eye injury, see a doctor.

Your child's doctor will usually ask you the following questions, depending on the type of injury:

• Does your child wear contact lenses for extended periods of time?
• Was your child near any chemicals or tools that could result in projectiles (such as a lawn mower or certain power tools)?
• Has there been any discharge from the eye?
• What, if any, types of first aid have you administered?

Your pediatrician may refer your child to an ophthalmologist to perform a physical exam. The ophthalmologist will examine your child’s eye using one or more of the following tests:

• Seidel's test: The doctor places a fluorescein-moistened strip over the affected area to see if there is an open globe injury.
• pH test: In the case of a chemical trauma, the ophthalmologist may perform a pH test. The doctor will irrigate the eye with saline and then use litmus paper to check the eye's pH against a healthy control.
• Eye shield: If the doctor suspects a globe injury, he may apply a rigid shield over the eye ahead of treatment. 

If your child has any type of eye injury, you should see an ophthalmologist as soon as possible. Eye injuries are a leading cause of vision impairment in kids, so early treatment can save your child's sight. Often, frequent examinations will be needed until the eye is completely healed.

Treatment will depend on the type and severity of the eye injury:

• Lacerations to the eyelid can result in damage to the tear ducts and other eye structures. They are typically treated using microsurgery.
• Scratches on the cornea (the surface of the eye) may be treated with antibiotic eye drops or patching.
• Deeper lacerations (such as with a stick or glass) put a child at risk for permanent vision loss. They need immediate attention and, most often, surgery.
• Fractures to the bones surrounding the eye usually require surgery to repair the damage and to prevent complications, including vision loss.
• Bleeding caused by blunt traumas can increase pressure in the eye. An ophthalmologist will determine the best course of treatment.
• Chemicals or other harmful substances in the eyes need to be immediately flushed out with water. You should see a doctor or visit an emergency room promptly. Bring a sample of the solution with you so the doctor can decide on the best treatment for your child.

Prognosis

If an eye injury is superficial, your child has a good chance of a full recovery. Most small foreign bodies that don't cause infection won't threaten a child's vision either. More serious injuries (such as damage to the globe) can result in complications, including glaucoma or retinal damage, down the road. Eye injuries in younger kids (10 and under) can be more complicated because their visual systems are still developing. The best treatment for eye injuries in children is prevention.