A small gauge needle may be used in older, cooperative children, using slit lamp with approach to the patient from the temporal aspect of the eye
Exclude entrapment of extraocular muscles with orbital fractures.A difference of greater than 2 lines (on an eye chart) between the eyes is likely to be significant.Test each eye separately, then together (for diplopia) with appropriate chart.A young child may become distressed if the 'good' eye is occluded.Kay picture book (available in ED), useful from 2-3 years of age.'E' chart: useful from about 3 years of age.Use age-appropriate charts and the patient's normal corrective lenses or pinhole: Topical anaesthetic such as amethocaine 1% (one drop) may be used once in the emergency department (local anaesthetic causes direct epithelial toxicity and should not be used repeatedly).įor obvious penetrating eye injuries (see Adequate analgesia will aid assessment.If an adequate examination is not possible due either to the child's age or cooperation level, specialist assistance should be sought. Visual disturbance, either temporary or persisting, including flashes (retinal detachment) or floaters (intra-ocular) in vision.
When assessing the painful eye, the following questions should be asked: Contact lens-related corneal infections (bacterial keratitis).Corneal burns, either chemical or thermal- alkalis penetrate deeper and have greater potential for serious and delayed burns.Large hyphaemas (causing acute glaucoma).The following traumatic conditions threaten vision: Serious eye injuries can be under-appreciated when children present with a painful eye or blurred vision.