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Pediatric Ocular Pediatric Ocular Trauma and Trauma and EmergenciesEmergencies

Dafina M. Good, MDDafina M. Good, MDEmory University School of MedicineEmory University School of Medicine

Children’s Healthcare of AtlantaChildren’s Healthcare of Atlanta

Pediatric Emergency Medicine FellowPediatric Emergency Medicine Fellow

ObjectivesObjectives

To Review the Epidemiology of Ocular To Review the Epidemiology of Ocular injuriesinjuries

To Review Normal Eye AnatomyTo Review Normal Eye Anatomy To Discuss a systematic approach to Eye To Discuss a systematic approach to Eye

examsexams To Review Common Ocular injuries and To Review Common Ocular injuries and

emergenciesemergencies To Review Preventive approaches for ocular To Review Preventive approaches for ocular

trauma trauma

Epidemiology of Eye Epidemiology of Eye InjuriesInjuries

One of the most preventable causes of visual impairment One of the most preventable causes of visual impairment in the WORLD……. in the WORLD……. From sports to war bombingsFrom sports to war bombings

An estimated 2.4 million eye injuries occur in United An estimated 2.4 million eye injuries occur in United States each year with 40,000 cases of vision lossStates each year with 40,000 cases of vision loss

The 2000 Kids’ Inpatient Database of the Healthcare Cost The 2000 Kids’ Inpatient Database of the Healthcare Cost and Utilization Project showed more than 7500 and Utilization Project showed more than 7500 hospitalizations for the treatment of pediatric eye injuries hospitalizations for the treatment of pediatric eye injuries that resulted in more than $88 million in inpatient chargesthat resulted in more than $88 million in inpatient charges

Up to 40% of all ocular injuries occur in persons less than Up to 40% of all ocular injuries occur in persons less than 17 years old17 years old

Eye injuries are the leading cause of visual disability and Eye injuries are the leading cause of visual disability and noncongenital unilateral blindness in childrennoncongenital unilateral blindness in children

In some studies, Up to 60% of pediatric eye injuries occur In some studies, Up to 60% of pediatric eye injuries occur during sports and recreational events during sports and recreational events

Other studies show that the home has become the more Other studies show that the home has become the more common place for pediatric eye injuriescommon place for pediatric eye injuries

Epidemiology of Eye Injuries Epidemiology of Eye Injuries cont’dcont’d

Males account for almost 70% of all Males account for almost 70% of all ocular injuriesocular injuries

BoysBoys between 11 and 15 years are the between 11 and 15 years are the most vulnerable… most vulnerable… 4 to1 ratio4 to1 ratio compared compared to girlsto girls

Why is that…………..Why is that…………..

Any Any SPORTSSPORTS that include balls, rackets, and sticks can that include balls, rackets, and sticks can be hazardous…… be hazardous…… Rough sportsRough sports and and projectilesprojectiles,, including toys, guns, darts, stones, air guns, paintballs, including toys, guns, darts, stones, air guns, paintballs, and BB guns and BB guns

Normal Eye AnatomyNormal Eye Anatomy

Normal Eye Anatomy with Bony Normal Eye Anatomy with Bony StructuresStructures

Lacrimal System Lacrimal System

The HistoryThe History

Stop….. Emergency…Stop….. Emergency… if Chemical if Chemical burns, proceed to provide copious irrigation burns, proceed to provide copious irrigation before history and physical exam is donebefore history and physical exam is done

The history…….The history……. Details and Mechanism of injury…………… Details and Mechanism of injury……………

Where, When, How, and With what?Where, When, How, and With what? Symptoms- pain, vision loss, double vision Symptoms- pain, vision loss, double vision

etcetc History of eyeglasses or contactsHistory of eyeglasses or contacts Medical HistoryMedical History

The Eye ExamThe Eye Exam

Stop….. Emergency…Stop….. Emergency… if Chemical burns, if Chemical burns, proceed to provide copious irrigation before eye proceed to provide copious irrigation before eye exam is doneexam is done

Visual AcuityVisual Acuity “The vital sign of the eyes” “The vital sign of the eyes” External anatomy examExternal anatomy exam….. Looking for trauma, ….. Looking for trauma,

foreign bodies, lids and conjunctiva, bony step offs, foreign bodies, lids and conjunctiva, bony step offs, proptosis, enopthalmos…. proptosis, enopthalmos…. Any deviations from Any deviations from normal anatomynormal anatomy

Pupillary response, Extraocular movements, and Pupillary response, Extraocular movements, and Visual fieldsVisual fields

Fundoscopic examFundoscopic exam…. red reflex and evaluation of …. red reflex and evaluation of the retina, blood vessels and optic nervethe retina, blood vessels and optic nerve

The Eye Exam The Eye Exam cont’dcont’d

Fluorescein ExamFluorescein Exam…… Using topical anesthetics Tetracaine (onset of action <1min) Using topical anesthetics Tetracaine (onset of action <1min)

or Proparacaine (onset <20 secs)or Proparacaine (onset <20 secs) Applying sterile fluorescein eye strips with saline or Applying sterile fluorescein eye strips with saline or

anestheticanesthetic Used with Wood’s light or Cobalt blue lightUsed with Wood’s light or Cobalt blue light

Slit Lamp ExamSlit Lamp Exam……..Primarily e……..Primarily examines the xamines the Anterior Chamber looking at the cornea, intraocular Anterior Chamber looking at the cornea, intraocular pressure and evaluating for foreign bodiespressure and evaluating for foreign bodies

Dilated eye examDilated eye exam allows the slit lamp exam to be allows the slit lamp exam to be used to view the Posterior globe as well (the retina, optic used to view the Posterior globe as well (the retina, optic nerve, blood vessels, and the macula)nerve, blood vessels, and the macula)

CT Scans CT Scans are the radiologic study of choice in are the radiologic study of choice in ophthalmologic emergenciesophthalmologic emergencies

Plain films Plain films are useful in some instancesare useful in some instances

Components of the Eye Components of the Eye ExamExam

Dilated Eye ExamDilated Eye Exam

Case #1Case #1

A 10yr old girl was playing with her A 10yr old girl was playing with her cousins and got poked in the eye and cousins and got poked in the eye and now c/o pain, redness and tearingnow c/o pain, redness and tearing

After a complete history and eye After a complete history and eye exam you find this on your exam you find this on your fluorescein test……..fluorescein test……..

Corneal AbrasionsCorneal Abrasions

Corneal AbrasionsCorneal Abrasions Probably the more common eye injury visit to the Probably the more common eye injury visit to the

EDED Usually present with pain, tearing, photophobia, Usually present with pain, tearing, photophobia,

FB sensationFB sensation Topical anesthetics when applied for fluorescein Topical anesthetics when applied for fluorescein

exam provide temporary reliefexam provide temporary relief Treatment usually consist of Topical Antibiotic Treatment usually consist of Topical Antibiotic

dropsdrops Pain MedicationPain Medication No patching in children!No patching in children!

Case #2Case #2

A 12yr old boy was in the garage A 12yr old boy was in the garage with his dad while he was drilling with his dad while he was drilling and started to c/o pain, tearing, like and started to c/o pain, tearing, like something was stuck in his eyesomething was stuck in his eye

After your thorough history and eye After your thorough history and eye exam…… with eversion of the lids exam…… with eversion of the lids you findyou find

Conjunctival/Corneal FBConjunctival/Corneal FB

Conjunctival/Corneal FBConjunctival/Corneal FB

Usually present with similar sx’s as abrasionsUsually present with similar sx’s as abrasions ImportantImportant to evert the eyelids using a cutip! to evert the eyelids using a cutip! Treatment involves Treatment involves

Removing the FB….. Removing the FB….. Apply a topical anesthetic FIRST!Apply a topical anesthetic FIRST! Using gentle irrigation or Cotton tip applicator attempt Using gentle irrigation or Cotton tip applicator attempt

to remove the objectto remove the object If not successful, in cooperative patients a sterile needle If not successful, in cooperative patients a sterile needle

can be used while resting your hands on the pts cheek… can be used while resting your hands on the pts cheek… If cornea involved best to get Ophthalmology to remove If cornea involved best to get Ophthalmology to remove the FB with a needlethe FB with a needle

Topical antibioticsTopical antibiotics

Case #3Case #3

A 16yr old boy gets into a fight at A 16yr old boy gets into a fight at school and has lacerations on his school and has lacerations on his forearms from a knife and he is forearms from a knife and he is holding his eye in painholding his eye in pain

When you examine his eye…… You When you examine his eye…… You findfind

Corneal/Scleral Corneal/Scleral LacerationsLacerations

Corneal/Scleral Corneal/Scleral LacerationsLacerations

Usually sustained during penetrating or blunt traumaUsually sustained during penetrating or blunt trauma Corneoscleral Lacerations are repaired surgically by Corneoscleral Lacerations are repaired surgically by

OphthamologyOphthamology Concerns that ocular tissue may prolapse through the Concerns that ocular tissue may prolapse through the

wound depending on extent of wound and intraocular wound depending on extent of wound and intraocular pressurepressure

ED ManagementED Management Most important PE component is to document visual acuity Most important PE component is to document visual acuity Shield the eye and Ophthalmology consultShield the eye and Ophthalmology consult Cycloplegics may be used to relieve ciliary muscle spasms Cycloplegics may be used to relieve ciliary muscle spasms

(which can cause tissue prolapse)(which can cause tissue prolapse) Provide Tetanus prophylaxisProvide Tetanus prophylaxis IV AntibioticsIV Antibiotics

Orbital CT scanOrbital CT scan may be useful if suspected FB pierced may be useful if suspected FB pierced through the corneathrough the cornea

Case #4Case #4

A 5yr old was running and fell and A 5yr old was running and fell and hit his face on a metal object and cut hit his face on a metal object and cut his eyelidhis eyelid

What do you want to know……and What do you want to know……and Why?Why?

Where on the Lid? Where on the Lid?

Lid LacerationsLid Lacerations

Let’s Review again the Let’s Review again the Lacimal System……Lacimal System……

Eyelid LacerationsEyelid Lacerations

ED managementED management Eye examEye exam Tetanus prophylaxisTetanus prophylaxis Wound closure if superficial lacerationWound closure if superficial laceration

Consult Ophthamology if……Consult Ophthamology if…… It involves the medial 1/3 lid (Canaliculi injury)It involves the medial 1/3 lid (Canaliculi injury) Lid margins (tarsal plate)Lid margins (tarsal plate) Levator palpebra muscle (ptosis may develop)Levator palpebra muscle (ptosis may develop)

Case #5Case #5

A 16yr old boy playing baseball was A 16yr old boy playing baseball was at 3at 3rdrd base and got hit in the eye base and got hit in the eye with the baseball after the hitter hit with the baseball after the hitter hit the ballthe ball

And before entering the room you And before entering the room you see the CT from the outside see the CT from the outside facility…..facility…..

Globe Rupture with Orbital Globe Rupture with Orbital FractureFracture

Globe RuptureGlobe Rupture

Globe RuptureGlobe Rupture

Mechanism of injury usually occurs with Mechanism of injury usually occurs with blunt, penetrating or perforating objectsblunt, penetrating or perforating objects

Often globe rupture is obvious on exam but Often globe rupture is obvious on exam but sometimes can be more subtlesometimes can be more subtle Symptoms… PAIN, greatly decreased vision, Symptoms… PAIN, greatly decreased vision,

diplopiadiplopia Signs…. Teardrop pupil, prolapsed iris, hyphemaSigns…. Teardrop pupil, prolapsed iris, hyphema PE…… Focused…..Visual acuity (counting PE…… Focused…..Visual acuity (counting

fingers) or light perception, EOM’s examined for fingers) or light perception, EOM’s examined for entrapmententrapment

Peaked PupilPeaked Pupil

Pupil peaks in the….. direction of the injury

Seidel’s TestSeidel’s Test

Fluorescein Eye Exam of Ruptured Globe

Let’s Review Again…. the Eye Let’s Review Again…. the Eye AnatomyAnatomy

Ruptured GlobeRuptured Globe ED ManagementED Management

Goal….. To Avoid any increases in intraocular Goal….. To Avoid any increases in intraocular pressurepressure

Shield the eye (Never patch!)Shield the eye (Never patch!) Pain relief Please!!!Pain relief Please!!! Antiemetics Antiemetics NPONPO Tetanus ProphylaxisTetanus Prophylaxis Broad Spectrum IV Broad Spectrum IV

Antibiotics….Ancef/Ceftaz/Vanco Antibiotics….Ancef/Ceftaz/Vanco (depends on the (depends on the surgeon) surgeon)

5-10% of penetrating injuries at risk for endopthalmitis, which leads to 5-10% of penetrating injuries at risk for endopthalmitis, which leads to vision lossvision loss

Ophthamology Consult Immediately!!!Ophthamology Consult Immediately!!!

Case #6Case #6

You asked her to Look up…. What are you suspicious of?

Orbital Floor FractureOrbital Floor Fracture

Orbital Floor FracturesOrbital Floor Fractures Mechanism of injury usually blunt forceMechanism of injury usually blunt force The weakest area of the orbital bones is The weakest area of the orbital bones is

the orbital floor/ maxillary roof aka “Blow the orbital floor/ maxillary roof aka “Blow out Fracture”out Fracture”

Signs/Sx’s… Signs/Sx’s… Eyelid swelling and EcchymosisEyelid swelling and Ecchymosis Enophthalmos “sinking in” of the affected eye Enophthalmos “sinking in” of the affected eye Ptosis Ptosis DiplopiaDiplopia Anesthesia of the cheek (infraorbital nerve) Anesthesia of the cheek (infraorbital nerve) Inability to move the eye upwardInability to move the eye upward

Orbital FracturesOrbital Fractures

ED ManagementED Management Orbital CT…Orbital CT… is not routinely indicated unless is not routinely indicated unless

limitation of motionlimitation of motion

Plain films may be helpful… Plain films may be helpful… A/F levels, A/F levels, Orbital emphysemaOrbital emphysema

3views Water’s, Caldwell and Lateral Views3views Water’s, Caldwell and Lateral Views

Orbital FracturesOrbital Fractures Management Management

Tetanus prophylaxisTetanus prophylaxis Surgery is not always indicatedSurgery is not always indicated Arranging Ophthamology follow up for possible Arranging Ophthamology follow up for possible

surgical repairsurgical repair Surgery is most commonly performed after 7-14daysSurgery is most commonly performed after 7-14days

Indications for surgery… Entrapped muscle, facial hypoesthesia, Indications for surgery… Entrapped muscle, facial hypoesthesia, symptomatic diplopia w/ minimal improvement over time, large floor symptomatic diplopia w/ minimal improvement over time, large floor fracture leading to enophthalmosfracture leading to enophthalmos

Observation…. Minimal diplopia, good ocular movement, no significant Observation…. Minimal diplopia, good ocular movement, no significant enophthalmosenophthalmos

Prophylactic AntibioticsProphylactic Antibiotics may be an option depending on may be an option depending on the surgeon as sinus involvement may lead to deeper infectionsthe surgeon as sinus involvement may lead to deeper infections

Tell patients to avoid blowing their noseTell patients to avoid blowing their nose

Case #7Case #7

A 3yr old African American girl A 3yr old African American girl comes in with eye pain after getting comes in with eye pain after getting hit in the eye with a toy truck………..hit in the eye with a toy truck………..

What are the clues to this case What are the clues to this case diagnosis?diagnosis?

HyphemaHyphemaGrade 1Grade 1

HyphemaHyphemaGrade 2Grade 2

HyphemasHyphemas Blood in the Anterior ChamberBlood in the Anterior Chamber Mechanism of injury usually blunt, Mechanism of injury usually blunt, projectileprojectile or or

penetrating traumapenetrating trauma Occurs 70% of the time in the Pediatric populationOccurs 70% of the time in the Pediatric population Majority (80%) of hyphemas have less than 50% of the Majority (80%) of hyphemas have less than 50% of the

anterior chamber filled with bloodanterior chamber filled with blood Signs/Sx’sSigns/Sx’s…. Pain, Decreased vision, injected …. Pain, Decreased vision, injected

conjunctiva, irregular pupil conjunctiva, irregular pupil The following clinical grading system for traumatic The following clinical grading system for traumatic

hyphemas is preferred:hyphemas is preferred: Grade 1 - Layered blood occupying less than one third of the anterior Grade 1 - Layered blood occupying less than one third of the anterior

chamber chamber Grade 2 - Blood filling one third to one half of the anterior chamber Grade 2 - Blood filling one third to one half of the anterior chamber Grade 3 - Layered blood filling one half to less than total of the Grade 3 - Layered blood filling one half to less than total of the

anterior chamber anterior chamber Grade 4 - Total clotted blood, often referred to as blackball or 8-ball Grade 4 - Total clotted blood, often referred to as blackball or 8-ball

hyphemahyphema

HyphemasHyphemas ComplicationsComplications

Secondary Hemorrhage (Rebleeding)Secondary Hemorrhage (Rebleeding) Most likely due to lysis and retraction of the clot and fibrin Most likely due to lysis and retraction of the clot and fibrin

aggregatesaggregates High risk of rebleeding within the first 5 daysHigh risk of rebleeding within the first 5 days Occurs in almost 25% of all patients with hyphemas (range, 7-38%)Occurs in almost 25% of all patients with hyphemas (range, 7-38%) Higher Grade of Hyphema increases risk of rebleedingHigher Grade of Hyphema increases risk of rebleeding Increased risk with younger ages…. Up to 30% of patients younger Increased risk with younger ages…. Up to 30% of patients younger

than 6 yrs old have secondary hemorrhages than 6 yrs old have secondary hemorrhages Occurs 2-5% in blue eyed individuals and 25-40% in African Occurs 2-5% in blue eyed individuals and 25-40% in African

AmericansAmericans Decreases recovery of visual acuity of 20/50 to about 60-65%Decreases recovery of visual acuity of 20/50 to about 60-65%

Corneal blood staining, Optic Atrophy, Anterior/Posterior Corneal blood staining, Optic Atrophy, Anterior/Posterior SynechiaeSynechiae

Prognosis/OutcomesPrognosis/Outcomes Judged by regaining near normal visual acuityJudged by regaining near normal visual acuity Visual acuity, is good in approximately 75-80% of patients Visual acuity, is good in approximately 75-80% of patients

Approximately 80% of those with Grade 1Hyphema, regain visual Approximately 80% of those with Grade 1Hyphema, regain visual acuity of 20/40, 60% of those with a Grade 3 hyphema, regain acuity of 20/40, 60% of those with a Grade 3 hyphema, regain visual acuity of 20/40 or better, while only approximately 35% of visual acuity of 20/40 or better, while only approximately 35% of those with an initially total hyphema or a Grade 4 hyphema have those with an initially total hyphema or a Grade 4 hyphema have good visual results. good visual results.

HyphemasHyphemas ManagementManagement

Elevate the head of the bed 30-45ºElevate the head of the bed 30-45º Eye shieldEye shield Pain control (Avoid antiplatelet effects of certain Pain control (Avoid antiplatelet effects of certain

NSAIDS)NSAIDS) Hospitalization vs. Outpatient BedrestHospitalization vs. Outpatient Bedrest

Risk of Rebleeding?Risk of Rebleeding? Grade of Hyphema (Grade 2 or higher)Grade of Hyphema (Grade 2 or higher) IOP at time of presentation (>30mm Hg)IOP at time of presentation (>30mm Hg)

Topical Cycloplegics(Atropine/Tropicamide)Topical Cycloplegics(Atropine/Tropicamide) Reduce ciliary muscle spasms and Dilate the irisReduce ciliary muscle spasms and Dilate the iris

Topical MioticsTopical Miotics Lowers IOP and increases the surface area of the iris and enhance Lowers IOP and increases the surface area of the iris and enhance

hyphema resorptionhyphema resorption Topical vs Systemic AMICAR (Aminocaproic acid)Topical vs Systemic AMICAR (Aminocaproic acid)

AntifibrinolyticAntifibrinolytic Prevention of normally occurring clot lysis allows blood Prevention of normally occurring clot lysis allows blood

vessels time to repairvessels time to repair Topical vs Systemic SteroidsTopical vs Systemic Steroids

Decreases the associated iritis and development of synechiaeDecreases the associated iritis and development of synechiae Sickle Cell prepSickle Cell prep in African Americans of unknown statusin African Americans of unknown status

Subconjunctival Subconjunctival HemorrhageHemorrhage

Subconjunctival Subconjunctival HemorrhageHemorrhage

What’s Wrong with this What’s Wrong with this picture?picture?

Retrobulbar HemorrhageRetrobulbar Hemorrhage

Retrobulbar hemorrhageRetrobulbar hemorrhage Mechanism of injury usually after blunt or Mechanism of injury usually after blunt or

penetrating injurypenetrating injury Signs/Sx’s….. Acute proptosis, subconjunctival Signs/Sx’s….. Acute proptosis, subconjunctival

hemorrhage, decreased vision, pain, limitation of hemorrhage, decreased vision, pain, limitation of ocular movementocular movement

May lead to loss of vision because of central May lead to loss of vision because of central retinal vessel occlusion…. From hemorrhage retinal vessel occlusion…. From hemorrhage compression in the posterior eye compression in the posterior eye

ED ManagementED Management Immediate Ophthamology Consult!Immediate Ophthamology Consult! IV Mannitol- to decrease IOP IV Mannitol- to decrease IOP IV steroidsIV steroids Lateral canthotomy (by experienced person)Lateral canthotomy (by experienced person)

The “The “True”True” Eye Eye EmergencyEmergency

The “The “True”True” Eye Eye EmergencyEmergency

Roper-Hall Classification Roper-Hall Classification TableTable

GradeGrade PrognosisPrognosis Limbial Limbial IschemiaIschemia

Corneal InvolvementCorneal Involvement

II GoodGood NoneNone Epithelial DamageEpithelial Damage

IIII GoodGood Less than 1/3Less than 1/3 Haze but the iris Haze but the iris details are visibledetails are visible

IIIIII GuardedGuarded 1/3 to 1/21/3 to 1/2 Total epithelial loss Total epithelial loss with haze that obscures with haze that obscures

the iris detailsthe iris details

IVIV PoorPoor Greater than Greater than 1/21/2

Cornea Opaque with Cornea Opaque with the iris and pupil the iris and pupil

obscuredobscured

IRRIGATION!!IRRIGATION!!

Chemical BurnsChemical Burns No history, No physical examNo history, No physical exam…………….. ……………..

Copious Irrigation is key…..1 to 2L of saline or Copious Irrigation is key…..1 to 2L of saline or lactated ringerslactated ringers

Immediately begin irrigation for 30mins……… until the pH of the Immediately begin irrigation for 30mins……… until the pH of the eye is near neutral at 7.0 using Litmus papereye is near neutral at 7.0 using Litmus paper

Time is of the essence with chemical burns to the eyeTime is of the essence with chemical burns to the eye Acid burns cause coagulation necrosis and denature surface Acid burns cause coagulation necrosis and denature surface

proteins but usually don’t penetrate the eyeproteins but usually don’t penetrate the eye Battery fluid and chemistry labs solutionsBattery fluid and chemistry labs solutions

Alkali burns are more harmful than acid burnsAlkali burns are more harmful than acid burns Alkali burns cause rapid penetration through the cornea and Alkali burns cause rapid penetration through the cornea and

anterior chamber combining with cell membrane lipidsanterior chamber combining with cell membrane lipids Alkali burns cause corneal liquefaction necrosisAlkali burns cause corneal liquefaction necrosis Lye, cement cleaner, drain cleaner, fertilizer, sparklers, and Lye, cement cleaner, drain cleaner, fertilizer, sparklers, and

firecrackers produce alkaline burns because they contain sodium firecrackers produce alkaline burns because they contain sodium hydroxidehydroxide

Chemical BurnsChemical Burns

ED ManagementED Management AfterAfter 30 minutes of copious irrigation…… 30 minutes of copious irrigation……

and Neutralized Eye pH of 7.0 and Neutralized Eye pH of 7.0 H&P H&P Visual acuity assessmentVisual acuity assessment Fluorescein…. To check for epithelial Fluorescein…. To check for epithelial

defects defects Ophthamology consultOphthamology consult… … if severe if severe

burn, subnormal vision or epithelial defects burn, subnormal vision or epithelial defects May require corneal or limbal May require corneal or limbal

transplantation?transplantation?

What can we do to “Save What can we do to “Save Eyes”?Eyes”?

Prevention, Prevention, PreventionPrevention, Prevention, Prevention ““Almost 90% of eye injuries could have Almost 90% of eye injuries could have

been prevented or decreased in severity been prevented or decreased in severity with better education, appropriate use of with better education, appropriate use of safety eyewear and removal of common safety eyewear and removal of common and dangerous risk factors”and dangerous risk factors”

Education, Education, EducationEducation, Education, Education Educate our children, families, and schools Educate our children, families, and schools

about the importance of safety eyewear about the importance of safety eyewear

SummarySummary The Eyes are very important!!! The Eyes are very important!!! The Eyes are small but very complex!!!The Eyes are small but very complex!!! Ocular injury is the leading cause of Ocular injury is the leading cause of preventable preventable

vision loss or blindness worldwidevision loss or blindness worldwide Using a systematic approach to the eye exam is Using a systematic approach to the eye exam is

bestbest Ocular trauma can be mild to severe and lead to Ocular trauma can be mild to severe and lead to

blindnessblindness Ouch…. Pain control PLEASE!Ouch…. Pain control PLEASE! When in doubt give a tetanus shotWhen in doubt give a tetanus shot Over 90% of eye injuries can be prevented with Over 90% of eye injuries can be prevented with

education and safety weareducation and safety wear When in doubt Consult Ophthamology!!! If it were When in doubt Consult Ophthamology!!! If it were

your child would you want Ophthamology called???your child would you want Ophthamology called???

The EndThe End

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Hamid, Rukaiya, Newfield, Philippa. Pediatric Eye Emergencies. Hamid, Rukaiya, Newfield, Philippa. Pediatric Eye Emergencies. Anesthesiology Clinics of North AmericaAnesthesiology Clinics of North America 2001;19 1-7. 2001;19 1-7.

Naradzay, Jerry, Barish, R. Approach to Ophthalmologic Emergencies. Naradzay, Jerry, Barish, R. Approach to Ophthalmologic Emergencies. The Medical Clinics of North AmericaThe Medical Clinics of North America 2006;90305-328. 2006;90305-328.

Dua, Harminder, King, A, Joseph A. A new classification of ocular Dua, Harminder, King, A, Joseph A. A new classification of ocular surface burns. surface burns. British Journal of OphthalmologyBritish Journal of Ophthalmology 2001;85: 1379-1383. 2001;85: 1379-1383.

Sheppard, John et al. “Hyphema.” Sheppard, John et al. “Hyphema.” eMedicine.eMedicine. November 2006. November 2006. http://www.emedicine.com/oph/topic765.htm http://www.emedicine.com/oph/topic765.htm

Robson, Joe et al. “Globe Rupture.” eMedicine. July 2005. Robson, Joe et al. “Globe Rupture.” eMedicine. July 2005. http://www.emedicine.com/emerg/topic218.htm http://www.emedicine.com/emerg/topic218.htm

Suwarno, Omar. Assessing and managing ophthalmic emergencies. Suwarno, Omar. Assessing and managing ophthalmic emergencies. Journal of the American Academy of Physician AssistantsJournal of the American Academy of Physician Assistants 2003;16:18- 2003;16:18-33. 33.