What’s Your Diagnosis? Pediatric Ocular Trauma: Recognition and Management 

Welcome to this month’s What’s Your Diagnosis Challenge! But before we begin, check to see if you got last month’s case on Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department right.

Case Presentation: Pediatric Ocular Trauma: Recognition and Management 

EMS is bringing in a previously healthy 3-year-old girl with a pencil lodged in her left eye…  

The EMS provider does not report other injuries. He tells you the girl is awake, alert, and crying.  Her vital signs include a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, respiratory rate of 20 breaths/min, and oxygen saturation of 99% on room air. The EMS provider tells you that there are no focal neurological findings. The EMS provider asks you whether they should attempt removal of the pencil and if you have any other recommendations. 

Case Conclusion

Based on the description given by EMS, you suspected an open globe injury with possible brain involvement. You told EMS not to attempt removal of the pencil. On the patient’s arrival to the ED, she was calm and cooperative for a CT head scan. The CT scan confirmed intracranial involvement. Neurosurgery and ophthalmology were consulted. You elevated the head of the bed, started an IV, and gave the patient a dose of IV morphine and IV vancomycin and cefepime prior to transfer to the operating room for definitive management for foreign body removal. Ophthalmology repaired an open globe injury involving zone 2. The child recovered well and was discharged after a 3-day hospital stay. 

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Last Updated on September 27, 2022

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