Pediatric ocular trauma refers to an injury or trauma to a child's eye. Injuries can occur on bones around the eye, eyeball, tear drainage system, or eyelids. Children are more prone to ocular trauma due to their dynamic and playful nature. Research indicates that one of the leading causes of acquired blindness in children is ocular trauma. It is harmful because it may result in visual impairments or permanent blindness when the children are very young and barely into their future. Blindness has more social, emotional, and psychological implications on the child and the family than if an adult were affected.
Children and adults are affected differently because of the kinds of objects that cause injury, how the condition is assessed, and how the condition is managed. Children aged seven and below will likely develop amblyopia from ocular trauma. Evaluating children thoroughly is more challenging because they are unlikely to provide adequate historical information. Injuries range from scratches on the cornea's surface to perforations of the sclera (white of the eye) and cornea.
Literature shows that about 250,000 children globally are hospitalized annually due to serious eye injuries. Approximately 3.9 million children and adults suffer visual loss in both eyes from ocular trauma, while 18 million have loss of vision in one eye.
Ocular injuries can be categorized into two types:
- Adnexal injuries
- Open and closed globe - This type is an emergency requiring immediate attention
Ocular injury can also be classified as follows:
- Blunt trauma which occurs when the eye is struck by a ball, elbow, fist, etc.
- Chemical trauma when liquids like toxins, household cleaners, chlorine, etc. enter the child's eye
- Penetrating trauma when an object enters the eye. Such objects include pencils, projectiles, sticks, etc.
Causes & Risk Factors
Children typically get injured in the eye during play or when at school. They can also be injured by sharp objects, carelessly stored chemicals, and dog bites while at home. Dog bites can also occur outside the home setup. Besides blunt, chemical, and penetrating trauma, eye injury can also be caused by accidents, fireworks or explosives, a foreign body in the eye, or burns.
Other causes include hyphema (presence of blood in the anterior chamber), a detached retina, and corneal infection through wearing contact lenses. A blow-out fracture may occur during a fall or sports injury where the bones surrounding the eye get fractured. Boys, more than girls, are likely to have an ocular injury.
Signs & Symptoms
Signs and symptoms include:
- Eyelid injuries
- Scleral laceration
- Corneal laceration
- Injury to the eyeball
- Problems with vision
- Corneal abrasion or scratching
- Fracture of the bones surrounding the eye
- Damage to the tear drainage system (tear duct obstruction)
- Injuries leading to pain, tearing, eyelid swelling, and redness. These require immediate consultation with an ophthalmologist
Immediate medical attention must be sought from an ophthalmologist who will carefully assess the structures of the eye and visual function. Historical details or causes leading to the trauma are essential for proper diagnosis since not all traumas, such as blunt trauma, require treatment. Ocular trauma due to chemical injury or perforations is a high priority and requires immediate management. The doctor may want to know if the child wears contact lenses for extended periods, and if the child was exposed to chemicals or dangerous tools such as a lawnmower. Information on eye discharge is also important, and whether any first aid was administered. An eye shield may be placed over the eye for protection if the doctor thinks he is dealing with a globe injury.
The following tests may be performed:
- Seidel's test where the doctor checks for an open globe injury by putting a strip moistened with fluorescein over the affected site
- pH test if a chemical caused the trauma. The doctor uses saline to rinse the eye and litmus paper to assess the affected eye’s pH
- An X-ray or CT scan helps determine whether any fractures have trapped the tissues or muscles surrounding the eye. Should there be any entrapment, surgery is required as soon as possible to avoid long-term complications like vision loss, double vision, and abnormal appearance
Treatment aims to preserve vision and improve physical appearance. Treatment is also administered depending on the type and severity of the trauma. Injury caused by harmful chemicals requires emergency treatment. Plenty of water is used to flash out the chemical immediately, and the parent or guardian can do this as first aid before going to the emergency room. Parents are encouraged to bring with them the offending chemical to enable best treatment.
Medications like antibiotics can help treat injuries such as corneal scratching. The eye can also be patched to treat scratches. Certain medications can lower intraocular pressure occasioned by trauma. Surgery is considered if these medications do not lower the pressure.
Microsurgery can be used to treat eyelid lacerations to repair damaged tear ducts and other ocular structures. Immediate surgery is required in certain situations, such as when the eye is deeply lacerated from objects like glass or a stick. Surgery is also needed when the bones surrounding the eye are fractured. The procedure repairs the affected structures and prevents vision loss.
Prognosis & Long-Term Outlook
Chances of a full recovery are very high with superficial injuries such as those caused by small foreign bodies. However, serious injuries may lead to severe complications like glaucoma and damage to the retina despite treatment. Children under ten years old still have their visual systems developing, so ocular trauma may have more complications.
Prevention & Follow Up
The best treatment for pediatric ocular injury is prevention. For example, children who participate in sports like hockey, squash, paintball guns, baseball, etc., should wear protective goggles, safety glasses, or full-face masks throughout. Parents and caregivers should ensure they store chemicals safely. Children should also not be exposed to fireworks or firework festivals.
After treatment, the child will be followed up frequently until the eye is completely healed.