Children commonly present to emergency departments with eye complaints in the absence of antecedent trauma. Signs and symptoms of ocular disease are often nonspecific. Red, swollen, or painful eyes may represent benign or vision-threatening processes, making recognition and triage challenging for the emergency clinician.
Our recent issue An Evidence-based Approach to Nontraumatic Ocular Complaints in Children reviews the presentations of common nontraumatic ocular complaints and provides evidence-based recommendations for management in the emergency department.
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Here are a few key points:
- Helpful techniques to evaluate neonatal vision include dimming the lights, rocking, gently lowering the head below the body, or having the parent hold the patient upright over their shoulder.
- Topical anesthesia is a valuable adjunct to the ophthalmologic examination and can serve as a diagnostic tool to differentiate surface pathologies from deeper processes.
- Beyond fundoscopy, ophthalmoscopes are helpful in assessing posterior chamber and posterior segment pathology through evaluation of the red reflex. An abnormal red reflex can alert the clinician to vision-threatening disease such as neoplasm, cataract, or hemorrhage
- If available, use ocular point-of-care ultrasound to detect abnormalities in the lens, vitreous, retina, and optic nerve. It is contraindicated when globe rupture or high intraocular pressure is suspected, as pressure on the eye can prompt further injury.
Last Updated on January 26, 2023