Pediatric Ocular Trauma

In this episode, Sam Ashoo, MD, interviews Ami Shah, MD, MPH, and Don Walker, MD, about eye injuries in the pediatric population. 

Why ocular injuries? Why did you pick this topic?

What kind of injuries are included and at what age are they most common?

Injury zones and terminology

Differential Diagnosis

  • What should we keep in mind when we are confronted with an ocular injury? (Table 3)

Prehospital Care

  • What do our EMS colleagues need to keep in mind when transporting a child with an ocular injury?
  • How can they help us in the ED?

ED Evaluation

  • History: What’s important to know?
  • Physical: Visual acuity and eye exam
  • Diagnostics: Slit lamp, ocular pressure, US, CT, MRI

Treatment

  • Lid lacerations: Who repairs and when?
  • Orbital fractures: What should we be looking for? Why is it different in children? When does repair typically occur?
  • Corneal abrasions
  • Corneal foreign body
  • Chemical injuries: Irrigate with what and for how long?
  • Traumatic hyphema: Treatment, disposition
  • Traumatic iritis: Treatment, outcome
  • Open globe injuries
  • Retrobulbar hematoma – First 10 EM

Special Populations

  • Hemophilia, Von Willebrand disease
  • Sickle cell and trait
  • Neonates and infants
  • Contact lenses

Controversies and Cutting Edge

  • Ketamine
  • Tetanus
  • NSAIDs, topical?
  • Topical anesthetics
  • Visual acuity apps

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