Special Considerations in the Management of Pediatric Ocular Trauma
Trauma is one of the most important causes of ocular morbidity in childhood. The management of eye trauma in very young patients requires special consideration of issues common in or unique to this patient population. One issue is the evaluation and treatment of accidental or nonaccidental trauma despite inadequate patient cooperation or an unreliable history. If the physician uses force to examine the child’s eye, there is a risk of exacerbating the damage caused by penetrating wounds or blunt impact. When preliminary assessment indicates that prompt surgical treatment may be necessary, it is appropriate to defer detailed physical examination of the eye until the patient is in the operating room and under general anesthesia.
Another issue is the potential for the injury to cause amblyopia. In children younger than 5–7 years, deprivation amblyopia associated with traumatic cataract or other media opacity can cause severe, long-term reduction of vision even after appropriate management of the original physical damage. Minimizing the interval between the injury and the restoration of optimal media clarity and optics, including adequate aphakic refractive correction, is thus a high priority. Monocular occlusion following injury should be kept to a minimum; the expected benefit from an occlusive dressing must be weighed against the risk of disturbing binocular function or inducing amblyopia in a very young child.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.