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Pediatric Ocular Trauma: an Update

  • Pediatric Ophthalmology (SL Robbins, Section Editor)
  • Published:
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Abstract

Purpose of Review

This article will review the recent literature and discuss the unique aspects to the presentation, evaluation, and treatment of pediatric ocular trauma.

Recent Findings

Ocular trauma occurs disproportionately in the pediatric population with injury rates and mechanisms similar throughout the world with only minor variation.

Summary

Trauma in the pediatric population has the potential to cause devastating vision loss. Most injuries around the world present as closed-globe injuries; however, amongst those requiring hospitalization, open-globe injuries and traumatic hyphemas are common. Orbital fractures are relatively rare in the pediatric population, but they can present in a unique manner and the location of the fracture can vary based on the developmental stage of the orbital bones. The treatment of ocular trauma needs to be tailored to the particular injury; however, the first rule should be primum non nocere: first, do no harm.

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References

Papers of particular interest, published recently, have been highlighted as: • Of Importance •• Of major importance

  1. Prevent Blindness America. The scope of the eye injury problem.10/18/2016. Available from: http://www.preventblindness.org/sites/default/files/national/documents/fact_sheets/FS93_ScopeEyeInjury_0.pdf.

  2. • Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of eye-related emergency department visits. JAMA Ophthalmology. 2016;134(3):312–9. Reviews over 11 million emergency department visits for ocular complaints.

    Article  PubMed  Google Scholar 

  3. Brophy M, Sinclair SA, Hostetler SG, Xiang H. Pediatric eye injury-related hospitalizations in the United States. Pediatrics. 2006;117(6):e1263–71.

    Article  PubMed  Google Scholar 

  4. Mayouego Kouam J, Epee E, Azria S, Enyama D, Omgbwa Eballe A, Ebana Mvogo C, et al. Epidemiological, clinical and therapeutic features of pediatric ocular injuries in an eye emergency unit in Ile-de-France. Journal francais d’ophtalmologie. 2015;38(8):743–51.

    Article  CAS  PubMed  Google Scholar 

  5. Chakraborti C, Giri D, Choudhury KP, Mondal M, Datta J. Paediatric ocular trauma in a tertiary eye care center in Eastern India. Indian J Public Health. 2014;58(4):278–80.

    Article  PubMed  Google Scholar 

  6. Cao H, Li L, Zhang M, Li H. Epidemiology of pediatric ocular trauma in the Chaoshan Region, China, 2001-2010. PLoS One. 2013;8(4):e60844.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sharifzadeh M, Rahmanikhah E, Nakhaee N. Pattern of pediatric eye injuries in Tehran, Iran. Int Ophthalmol. 2013;33(3):255–9.

    Article  PubMed  Google Scholar 

  8. Kadappu S, Silveira S, Martin F. Aetiology and outcome of open and closed globe eye injuries in children. Clin Exp Ophthalmol. 2013;41(5):427–34.

    Article  PubMed  Google Scholar 

  9. Aghadoost D, Fazel MR, Aghadoost HR. Pattern of pediatric ocular trauma in Kashan. Archives of Trauma Research. 2012;1(1):35–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. El-Sebaity DM, Soliman W, Soliman AM, Fathalla AM. Pediatric eye injuries in upper Egypt. Clin Ophthalmol. 2011;5:1417–23.

    PubMed  PubMed Central  Google Scholar 

  11. Al-Mahdi HS, Bener A, Hashim SP. Clinical pattern of pediatric ocular trauma in fast developing country. International Emergency Nursing. 2011;19(4):186–91.

    Article  PubMed  Google Scholar 

  12. Lee CH, Su WY, Lee L, Yang ML. Pediatric ocular trauma in Taiwan. Chang Gung Med J. 2008;31(1):59–65.

    PubMed  Google Scholar 

  13. Saxena R, Sinha R, Purohit A, Dada T, Vajpayee RB, Azad RV. Pattern of pediatric ocular trauma in India. Indian J Pediatr. 2002;69(10):863–7.

    Article  PubMed  Google Scholar 

  14. Malagola R, Arrico L, Migliorini R, D’Ambrosio EM, Grenga R. Ocular traumatology in children. A retrospective study. Il Giornale di chirurgia. 2012;33(11–12):423–8.

    CAS  PubMed  Google Scholar 

  15. Dulal S, Ale JB, Sapkota YD. Profile of pediatric ocular trauma in mid western hilly region of Nepal. Nepalese Journal of Ophthalmology. 2012;4(1):134–7.

    Article  CAS  PubMed  Google Scholar 

  16. Podbielski DW, Surkont M, Tehrani NN, Ratnapalan S. Pediatric eye injuries in a Canadian emergency department. Can J Ophthalmol. 2009;44(5):519–22.

    Article  PubMed  Google Scholar 

  17. United States Census Bureau. Quick facts: United States. Available from: https://www.census.gov/quickfacts/table/PST045215/00.

  18. Pearlman JA, Au Eong KG, Kuhn F, Pieramici DJ. Airbags and eye injuries: epidemiology, spectrum of injury, and analysis of risk factors. Surv Ophthalmol. 2001;46(3):234–42.

    Article  CAS  PubMed  Google Scholar 

  19. • Bunting H, Stephens D, Mireskandari K. Prediction of visual outcomes after open globe injury in children: a 17-year Canadian experience. Journal of AAPOS. 2013;17(1):43–8. Reviews outcomes in 131 patients over 17 years with open-globe injuries. Also compared their outcomes to OTS and POTS in predicting final visual outcome.

    Article  PubMed  Google Scholar 

  20. Acar U, Tok OY, Acar DE, Burcu A, Ornek F. A new ocular trauma score in pediatric penetrating eye injuries. Eye. 2011;25(3):370–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lee R, Fredrick D. Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012. Journal of AAPOS. 2015;19(2):163-8.e1.

    Article  PubMed  Google Scholar 

  22. Listman DA. Paintball injuries in children: more than meets the eye. Pediatrics. 2004;113(1 Pt 1):e15–8.

    Article  PubMed  Google Scholar 

  23. Shah MA, Shah SM, Applewar A, Patel C, Patel K. Ocular trauma score as a predictor of final visual outcomes in traumatic cataract cases in pediatric patients. J Cataract Refract Surg. 2012;38(6):959–65.

    Article  PubMed  Google Scholar 

  24. Hossain A, Hussain E, Ferdausi N, Sen U, Islam Z. Prognostic value of ocular trauma score in evaluating visual outcome of pediatric (4-16 years) open globe injuries. Asia-Pacific Journal of Ophthalmology (Philadelphia). 2014;3(4):226–9.

    Article  Google Scholar 

  25. •• Abbott J, Shah P. The epidemiology and etiology of pediatric ocular trauma. Survey of ophthalmology. 2013;58(5):476–485. Reviews worldwide literature on trends in pediatric ocular trauma.

  26. Rohr JT, Santos PM, Santos RC, Vieira CV, Fe LM, Solano RL, et al. Profile of pediatric eye trauma at Hospital de Base do Distrito Federal (HBDF), Brasilia, Brazil. Revista da Associacao Medica Brasileira (1992). 2016;62(4):324–9.

    Article  Google Scholar 

  27. Oiticica-Barbosa MM, Kasahara N. Eye trauma in children and adolescents: perspectives from a developing country and validation of the ocular trauma score. J Trop Pediatr. 2015;61(4):238–43.

    Article  PubMed  Google Scholar 

  28. •• Li X, Zarbin MA, Bhagat N. Pediatric open globe injury: a review of the literature. Journal of Emergencies, Trauma, and Shock. 2015;8(4):216–23. Reviews worldwide literature on open-globe injuries.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wu H, Ding X, Zhang M, Xu G. Pediatric posttraumatic endophthalmitis. Graefe’s Archive for Clinical and Experimental Ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2016;254(10):1919–22.

    Article  PubMed  Google Scholar 

  30. Cain Jr W, Sinskey RM. Detection of anterior chamber leakage with Seidel’s test. Arch Ophthalmol. 1981;99(11):2013.

    Article  PubMed  Google Scholar 

  31. Ramsay JG, Rappaport BA. SmartTots: a multidisciplinary effort to determine anesthetic safety in young children. Anesth Analg. 2011;113(5):963–4.

    Article  PubMed  Google Scholar 

  32. Patel SN, Langer PD, Zarbin MA, Bhagat N. Diagnostic value of clinical examination and radiographic imaging in identification of intraocular foreign bodies in open globe injury. Eur J Ophthalmol. 2012;22(2):259–68.

    Article  CAS  PubMed  Google Scholar 

  33. Yonekawa Y, Chodosh J, Eliott D. Surgical techniques in the management of perforating injuries of the globe. Int Ophthalmol Clin. 2013;53(4):127–37.

    Article  PubMed  Google Scholar 

  34. Agrawal R, Shah M, Mireskandari K, Yong GK. Controversies in ocular trauma classification and management: review. Int Ophthalmol. 2013;33(4):435–45.

    Article  PubMed  Google Scholar 

  35. Lesniak SP, Bauza A, Son JH, Zarbin MA, Langer P, Guo S, et al. Twelve-year review of pediatric traumatic open globe injuries in an urban U.S. population. J Pediatr Ophthalmol Strabismus. 2012;49(2):73–9.

    Article  PubMed  Google Scholar 

  36. Choovuthayakorn J, Patikulsila P, Patikulsila D, Watanachai N, Pimolrat W. Characteristics and outcomes of pediatric open globe injury. Int Ophthalmol. 2014;34(4):839–44.

    Article  PubMed  Google Scholar 

  37. Sul S, Gurelik G, Korkmaz S, Ozdek S, Hasanreisoglu B. Pediatric open-globe injuries: clinical characteristics and factors associated with poor visual and anatomical success. Graefe’s Archive for Clinical and Experimental Ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2016;254(7):1405–10.

    Article  PubMed  Google Scholar 

  38. Kumar K, Mathai A, Murthy SI, Jalali S, Sangwan V, Reddy Pappuru R, et al. Sympathetic ophthalmia in pediatric age group: clinical features and challenges in management in a tertiary center in southern India. Ocul Immunol Inflamm. 2014;22(5):367–72.

    Article  PubMed  Google Scholar 

  39. Zheng C, Wu AY. Enucleation versus evisceration in ocular trauma: a retrospective review and study of current literature. Orbit. 2013;32(6):356–61.

    Article  PubMed  Google Scholar 

  40. Chaithanyaa N, Devireddy SK, Kishore Kumar RV, Gali RS, Aneja V. Sympathetic ophthalmia: a review of literature. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2012;113(2):172–6.

    Article  PubMed  Google Scholar 

  41. Niiranen M, Raivio I. Eye injuries in children. Br J Ophthalmol. 1981;65(6):436–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Khan M, Reichstein D, M Recchia F. Ocular consequences of bottle rocket injuries in children and adolescents. Arch Ophthalmol. 2011;129(5):639–42.

    Article  PubMed  Google Scholar 

  43. Singh J, Shah P, Sutton GA. Exploding eggs. N Engl J Med. 1991;325(24):1749.

    Google Scholar 

  44. Serrano JC, Chalela P, Arias JD. Epidemiology of childhood ocular trauma in a northeastern Colombian region. Arch Ophthalmol. 2003;121(10):1439–45.

    Article  PubMed  Google Scholar 

  45. Quezada-Del Cid NC, Zimmermann-Paiz MA, Ordonez-Rivas AM. Clinical and epidemiological characteristics of ocular trauma in children under 14 years of age. Archivos argentinos de pediatria. 2015;113(5):e260–3.

    PubMed  Google Scholar 

  46. SooHoo JR, Davies BW, Braverman RS, Enzenauer RW, McCourt EA. Pediatric traumatic hyphema: a review of 138 consecutive cases. Journal of AAPOS. 2013;17(6):565–7.

    Article  PubMed  Google Scholar 

  47. Coats DK, Viestenz A, Paysse EA, Plager DA. Outpatient management of traumatic hyphemas in children. Binocular Vision & Strabismus Quarterly. 2000;15(2):169–74.

    CAS  Google Scholar 

  48. Romano PE, Hope GM. The effect of age and ethnic background on the natural rebleed rate in untreated traumatic hyphema in children. Metabolic, Pediatric, and Systemic Ophthalmology (New York, NY: 1985). 1990;13(1):26–31.

    CAS  Google Scholar 

  49. Nasrullah A, Kerr NC. Sickle cell trait as a risk factor for secondary hemorrhage in children with traumatic hyphema. Am J Ophthalmol. 1997;123(6):783–90.

    Article  CAS  PubMed  Google Scholar 

  50. Haring RS, Sheffield ID, Channa R, Canner JK, Schneider EB. Epidemiologic trends of chemical ocular burns in the United States. JAMA Ophthalmology. 2016;134(10):1119–24.

    Article  PubMed  Google Scholar 

  51. Vajpayee RB, Shekhar H, Sharma N, Jhanji V. Demographic and clinical profile of ocular chemical injuries in the pediatric age group. Ophthalmology. 2014;121(1):377–80.

    Article  PubMed  Google Scholar 

  52. Gray ME, West CE. Corneal injuries from liquid detergent pods. Journal of AAPOS. 2014;18(5):494–5.

    Article  PubMed  Google Scholar 

  53. Capitena C, Glazier R, McCourt E, Enzenauer R, Braverman RS. Corneal injuries from liquid detergent pods. Journal of AAPOS. 2015;19(1):99–100.

    Article  PubMed  Google Scholar 

  54. Fayers T, Munneke R, Strouthidis NG. Detergent capsules causing ocular injuries in children. J Pediatr Ophthalmol Strabismus. 2006;43(4):250–1.

    PubMed  Google Scholar 

  55. Abelson MB, Udell IJ, Weston JH. Normal human tear pH by direct measurement. Arch Ophthalmol. 1981;99(2):301.

    Article  CAS  PubMed  Google Scholar 

  56. Joshi S, Kassira W, Thaller SR. Overview of pediatric orbital fractures. The Journal of Craniofacial Surgery. 2011;22(4):1330–2.

    Article  PubMed  Google Scholar 

  57. McGraw BL, Cole RR. Pediatric maxillofacial trauma. Age-related variations in injury. Archives of Otolaryngology—Head & Neck Surgery. 1990;116(1):41–5.

    Article  CAS  Google Scholar 

  58. Hink EM, Wei LA, Durairaj VD. Clinical features and treatment of pediatric orbit fractures. Ophthal Plast Reconstr Surg. 2014;30(2):124–31.

    Article  PubMed  Google Scholar 

  59. Wei LA, Durairaj VD. Pediatric orbital floor fractures. Journal of AAPOS. 2011;15(2):173–80.

    Article  PubMed  Google Scholar 

  60. Jordan DR, Allen LH, White J, Harvey J, Pashby R, Esmaeli B. Intervention within days for some orbital floor fractures: the white-eyed blowout. Ophthal Plast Reconstr Surg. 1998;14(6):379–90.

    Article  CAS  PubMed  Google Scholar 

  61. Egbert JE, May K, Kersten RC, Kulwin DR. Pediatric orbital floor fracture: direct extraocular muscle involvement. Ophthalmology. 2000;107(10):1875–9.

    Article  CAS  PubMed  Google Scholar 

  62. Bansagi ZC, Meyer DR. Internal orbital fractures in the pediatric age group: characterization and management. Ophthalmology. 2000;107(5):829–36.

    Article  CAS  PubMed  Google Scholar 

  63. Gart MS, Gosain AK. Evidence-based medicine: orbital floor fractures. Plast Reconstr Surg. 2014;134(6):1345–55.

    Article  CAS  PubMed  Google Scholar 

  64. Parbhu KC, Galler KE, Li C, Mawn LA. Underestimation of soft tissue entrapment by computed tomography in orbital floor fractures in the pediatric population. Ophthalmology. 2008;115(9):1620–5.

    Article  PubMed  Google Scholar 

  65. Kolk A, Stimmer H, Klopfer M, Wolff KD, Hohlweg-Majert B, Ploder O, et al. High resolution magnetic resonance imaging with an orbital coil as an alternative to computed tomography scan as the primary imaging modality of pediatric orbital fractures. Journal of Oral and Maxillofacial Surgery. 2009;67(2):348–56.

    Article  PubMed  Google Scholar 

  66. Khan S, Athwal L, Zarbin M, Bhagat N. Pediatric infectious endophthalmitis: a review. J Pediatr Ophthalmol Strabismus. 2014;51(3):140–53.

    Article  PubMed  Google Scholar 

  67. Thordsen JE, Harris L, Hubbard 3rd GB. Pediatric endophthalmitis. A 10-year consecutive series. Retina (Philadelphia). 2008;28(3 Suppl):S3–7.

    Article  Google Scholar 

  68. Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The ocular trauma score (OTS). Ophthalmol Clin N Am. 2002;15(2):163–5. vi

    Article  Google Scholar 

  69. Prevent Blindness America. Protect your child from eye injuries. Available from: http://www.preventblindness.org/protect-your-child-eye-injuries.

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Acknowledgements

The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.

I am a military service member. This work was prepared as part of my official duties. Title 17, USC, §105 provides that “Copyright protection under this title is not available for any work of the U.S. Government.” Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

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  1. Department of Ophthalmology, Naval Medical Center Portsmouth, 620 John Paul Jones Cr, Portsmouth, VA, 23708, USA

    Kyle E. Miller

  2. Department of Surgery, Uniformed Services University, Bethesda, MD, USA

    Kyle E. Miller

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Correspondence to Kyle E. Miller.

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This article is part of the Topical Collection on Pediatric Ophthalmology

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Miller, K.E. Pediatric Ocular Trauma: an Update. Curr Ophthalmol Rep 5, 107–113 (2017). https://doi.org/10.1007/s40135-017-0130-7

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