Injuries to the Eye

Published on 25/03/2015 by admin

Filed under Pediatrics

Last modified 25/03/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1260 times

Chapter 627 Injuries to the Eye

About 30% of all blindness in children results from trauma. Children and adolescents account for a disproportionate number of episodes of ocular trauma. Boys ages 11-15 yr are the most vulnerable; their injuries outnumber those in girls by a ratio of about 4 : 1. The majority of injuries are related to sports, toy darts, other projectiles, sticks, stones, fireworks, paint balls, and air-powered BB guns. The last causes particularly devastating ocular and orbital injuries. Much of the trauma is avoidable (Chapter 5.1). Any part of the orbit or globe may be affected (Fig. 627-1).

image

Figure 627-1 The injured eye.

(From Khaw PT, Shah P, Elkington AR: Injury to the eye, BMJ 328:36–38, 2004.)

Foreign Body involving the Ocular Surface

A foreign body usually produces acute discomfort, lacrimation, and inflammation. Most foreign bodies can be detected by examination in good light with the aid of magnification or a direct ophthalmoscope set on a high plus lens (+10 or +12). In many cases, slit-lamp examination is necessary, especially if the particle is deep or metallic. Some conjunctival foreign bodies tend to lodge under the upper eyelid, causing the sensation of corneal foreign body as they come into contact with the globe on eyelid movement; they can also produce vertically oriented linear corneal abrasions (Fig. 627-2). Finding these abrasions should lead to a suspicion of such a foreign body, and eversion of the lid may be necessary (Chapter 611). If a foreign body is suspected but not found, further examination is indicated. If the history suggests injury with a high-velocity particle, radiologic examination of the eye may be needed to explore the possibility of an intraocular foreign body.

Removal of a foreign body can be facilitated by instillation of a drop of topical anesthetic. Many foreign bodies can be removed by irrigating or by gently wiping them away with a moistened cotton-tipped applicator. Embedded foreign bodies or foreign bodies in the central cornea should be treated by an ophthalmologist. Removal of corneal foreign bodies can leave epithelial defects, which are treated as corneal abrasions. Metallic foreign bodies can cause rust to form in the corneal tissues; examination by an ophthalmologist 1 or 2 days after removal of a foreign body is recommended because a rust ring might require further treatment (curettage).