Eye trauma in childhood.

In summary, the following program should be useful for the physician who encounters a child with a suspected eye injury: 1. Obtain a history. What was the child doing when he hurt his eye? 2. Examine the child by first inspecting the lids. Evert the lids with a cotton tipped applicator if necessary and if the globe is intact. Look at the canalicular area and decide whether the lacrimal drainage system is disrupted. Is a lid laceration deep enough to affect the levator? Could the orbital rim or any bony structures be involved? Should an x-ray film for fracture or foreign body be obtained? Is the anterior segment of the globe intact? What is the condition of the conjunctiva and cornea? Should fluorescein stain be applied to the cornea in an attempt to determine the presence of corneal abrasion? Put proparacaine hydrochloride 0.5 per cent drops in the eye if it is too sensitive or photophobic to allow opening of the lids. Is there blood in the anterior chamber? Does the lens look opaque? Is the cornea lacerated, is the globe ruptured? Does the patient have double vision? Is the eye obviously displaced relative to the other eye? 3. Check visual acuity-! Visual acuity may be checked initially or after examination of the eye, but some recording of the visual acuity should always be made. An elegent chart is not necessary. The child may be asked to identify letters on a prescription pad or merely record the presence of light, count fingers, etc., whichever is nearest maximal visual potential. 4. A decision should be made with regard to further diagnostic techniques including the decision, should an ophthalmologist be consulted? 5. Treat minimal anterior segment or adnexal injuries with or without consultation with an ophthalmologist. 6. If the injury is extensive, resist the urge to do something immediately; merely patch the eye and put the child in the hands of an ophthalmologist.