Pediatric Ocular Injuries

1. Pediatric Ocular Injuries

2. Ocular Injuries Leading cause of monocular visual disability & monocular blindness in children. Severe eye injuries in children are not rare They can lead to significant visual impairment that can hinder child’s development. Ocular trauma in children is mainly accidental & has an age-specific pattern.

3. Ocular Injuries :Causes The causes of ocular injuries are diverse & tend to vary in different geographical areas. They are also related to the socio-economic status of the study population.

4. Ocular Injuries : Causes In the Indian scenario main causes are Wooden stick injuries & iron rods Pencils ,Pens scales . Broken glass bangles, & tea cup Toys like tops , bat, ball , bows and arrows etc. Sports Sharp edged objects and furniture at home

5. Ocular injuries: Symptoms Look out for Visual loss Bleeding on the surface or inside the eye Cur or tear in eye lid Swelling A foreign body inside the eye Sharp throbbing pain in the eye www.saveoursight.org/childsight4.aspx

6. Australian Study:Dr. C.G. Thompson (Port Macquarie Eye Centre)Prevalence, Age & Sex Of the 72 eye injuries: 15 injuries (21%) - children between 0 & 3 yrs old. 23 injuries (32%) - children between 3 & 6 yrs old. 18 injuries (25%) - children between 6 & 9 yrs old. 10 injuries (14%) - children between 9 & 12 yrs old. 6 injuries (8%) - children between 12 & 15 yrs old. More eye injuries occurred in boys (48 injuries; 67%) than in girls (24 injuries; 33%). However, in children younger than 3 yrs, boys (7 injuries) & girls (8 injuries) had about the same number of injuries. Most injuries (42 injuries; 58%) occurred at home. Surprisingly, only 1 injury occurred at school.

7. Eye Injury: Distribution by Age & Genderhttp://faculty.washington.edu/chudler/eyes.html

8. Comparison of age & sex : Penetrating injuriesBritish Journal of Ophthalmology 2002;86:920-922

9. Ocular Injuries: Types 1. Mechanical (a) Penetrating (b) Blunt 2 . Chemical 3 . Sports Activity 4 . Pets 5 . Accidents

10. Mechanical Trauma: Classification Ocular Trauma Classification Group recommendations . This system classifies ocular injuries according to four variables: (i) Type of injury based on the mechanism of injury. (ii) Grade of injury defined by visual acuity in the injured eye at the time of initial examination. (iii) Pupil defined as the presence or absence of a relative afferent pupillary defect in the injured eye. (iv) Zone of injury based on the anterioposterior extent of the injury. CURRENT SCIENCE, VOL. 89, NO. 1, 10 JULY 2005

11. Minor Injury : Resulting in Trauma

12. Ruptured eye Globe Due to a Golf Ball

13. Chemical Injuries Alkali burns are frequently more disastrous than those caused by acids, as alkalis saponify the lipids of cell membranes & produce total disruption of cells. eg. burns caused by lye, fresh lime, ammonia etc Acids quickly precipitate tissue proteins & are therefore less penetrating.

14. Chemical Eye Injury

15. Sports- Related Ocular Injuries

17. Injury: Diagnosis & detection Examination of the Globe Signs of potential globe rupture or perforation: Severe loss of vision or loss of red reflex Loss of ocular motility Asymmetric pupil Hyphema Distorted appearance of globe Localized conjunctival haemorrhage or chemosis Ref:http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5199

18. Visual Acuity test Snellen charts: from school-age 'E' chart: useful from about 3 yrs of age Test each eye separately, then together (for diplopia) with appropriate chart. A difference of greater than 2 lines (on an eye chart) between the eyes is likely to be significant.

19. Lids, conjunctiva & sclera Examine the lids including the undersides for trauma & foreign bodies. A topical anesthetic may aid examination.  For lid lacerations, examine to exclude full-thickness laceration & penetration of globe. Subconjunctival hemorrhage- if localized, may suggest penetrating injury.

20. Cornea, Anterior Chamber, Iris & Pupil Before fluorescein: Look for Pupillary light reflex, Pupil shape & size, s Symmetry with other eye, Presence of hyphema or cloudy cornea (prior to blood settling) or epithelial defects. After fluorescein: Look for corneal abrasions conjunctival abrasions or lacerations

21. Eye Injury : First Aid Try to determine how serious the injury is. If the eye is very painful, swollen, bleeding or unusual-looking, don't try to treat it yourself. Instead, take the child to the nearest emergency room.  If the eye is bloodshot, even without significant pain, get help; in more than one-fourth of cases, an underlying injury is present. Never give aspirin or ibuprofen to a child with bloodshot eyes. These drugs prolong bleeding & worsen the situation. 

22. Chemical Injury : First Aid If an irritating chemical is in the eye, rinse immediately with clear, cold water for at least ten minutes. The water washes out the chemical & neutralizes its acid-base balance so that it becomes less damaging.  Cover the eye with a patch & seek medical attention. If possible, find out exactly what is in the eye, & take the chemical's container to the emergency room. 

23. First Aid (Cont…) To remove dirt or an eyelash from the eye, grasp the lashes & pull the eyelid up & down a few times. If you can see the object, dab it with the tip of a tissue or handkerchief to remove it. If you can't see anything in the eye but the child complains of pain, wash the eye with cool water, which may flush out the object or bring it into view so that you can remove it.  If the eye & the skin around it are bruised (a black eye), cover the area with a wet towel or ice pack for ten minutes or longer. 

24. Prevention always better than cure Supervising or keeping a watchful eye on the child at home Educating the elders regarding hazards of ocular trauma & first aid measures in case of emergencies Taking appropriate measures like avoiding sharp corners of decorative articles show pieces , sharp edges of furniture when children are young. Educating the people regarding hazardous nature of firecrackers , sharp objects , tools , chemicals with respect to eye & vision. Children playing with pets require supervision & education on how to treat pets

25. REMEBER Prevention is the best way to protect children’s sight.