Pediatric Primary Care (45 page)

2.  Emergency referral to ophthalmologist.

I.  Follow up.

1.  Per ophthalmologist.

J.  Complications.

1.  Loss of vision.

K.  Education.

1.  Prevention is most important.

2.  Need to know name of chemical in eye; acid burns affect cornea and anterior chamber of eye.

3.  Alkali burns can continue for days.

X.  CORNEAL ABRASION (SUPERFICIAL)

A.  Definition.

Scratched, abraded, or denuded cornea.

B.  Etiology.

1.  Usually due to accidental contact with object (fingernail, branches, bushes, paper, contact lens overwear).

C.  Occurrence.

1.  Can occur at any age.

D.  Clinical manifestations.

1.  Pain.

2.  Excessive tearing.

3.  Photophobia.

4.  Decreased vision.

E.  Physical findings.

1.  May see uneven light reflection or cloudiness of cornea.

2.  May see foreign body.

3.  After staining with fluorescein and using cobalt-blue light or Wood's lamp, will see area of green staining (persists with blinking).

4.  Decreased visual acuity.

F.  Diagnostic tests.

1.  Fluorescein staining and cobalt-blue light or Wood's lamp.

G.  Differential diagnosis.

1.  Foreign body.

H.  Treatment.

1.  Instill topical ophthalmic anti-infective ointment (erythromycin ophthalmic ointment or bacitracin/polymyxin B ophthalmic ointment).

2.  Patching not recommended.

I.  Follow-up.

1.  Recheck in 24-48 hours, or sooner if worsens.

J.  Complications.

1.  Infection.

2.  Impaired vision.

K.  Education.

1.  Frequent handwashing.

2.  Avoid use of contact lenses for at least 1 week following healing of abrasion.

XI. FOREIGN BODY (CONJUNCTIVAL, CORNEAL)

A.  Definition.

B.  Etiology.

1.  Usually object is airborne.

C.  Occurrence.

1.  Can occur at any age.

D.  Clinical manifestations.

1.  Excessive tearing.

2.  Photophobia.

3.  Sensation that something is in eye.

E.  Physical findings.

1.  Excessive tearing.

2.  Use bright light or magnification to visualize corneal and conjunctival surfaces for foreign body.

3.  May need to evert upper eyelid to find foreign body.

F.  Diagnostic tests.

1.  None.

G.  Differential diagnosis.

1.  Infection.

2.  Perforation of ocular globe.

H.  Treatment.

1.  Test visual acuity.

2.  Remove foreign body if possible with moistened, cotton-tipped applicator.

3.  After removal of foreign body, inspect for corneal abrasion using fluorescein.

4.  Refer to ophthalmologist if large abrasion or unable to find foreign body.

I.  Follow up.

1.  Recheck in 24 hours or sooner if worsens.

J.  Complications.

1.  Infection.

2.  Damage to cornea.

K.  Education.

1.  Avoid rubbing eyes.

2.  Teach prevention of eye injuries (protective eyewear).

XII. HEMORRHAGE (SUBCONJUNCTIVAL)

A.  Definition.

B.  Etiology.

1.  Sudden increase in intrathoracic pressure (coughing, sneezing).

2.  Direct ocular trauma.

C.  Occurrence.

1.  Can occur at any age.

D.  Clinical manifestations.

1.  Ruptured blood vessel in eye.

E.  Physical findings.

1.  Blotchy, bulbar erythema of conjunctiva.

F.  Diagnostic tests.

1.  None.

G.  Differential diagnosis.

1.  Ocular trauma.

H.  Treatment.

1.  None; will spontaneously resolve in 5-7 days.

2.  Refer to ophthalmologist if due to trauma.

I.  Follow up.

1.  No routine follow up necessary.

2.  Recheck if fails to disappear in 5-7 days, or worsens.

J.  Complications.

1.  Usually none.

K.  Education.

1.  Teach measures to avoid increasing intrathoracic pressure.

XIII. HYPHEMA

A.  Definition.

Blood in anterior chamber of eye.

B.  Etiology

1.  Usually due to blunt or perforating trauma to eye.

C.  Occurrence.

1.  Variable.

D.  Clinical manifestations.

1.  Bright or dark red area near iris.

2.  Painful.

E.  Physical findings.

1.  Bright or dark red fluid level between cornea and iris.

F.  Diagnostic tests.

1.  X-rays, CT scan for other injuries.

G.  Differential diagnosis.
Foreign body, conjunctival, 930.1

1.  Type of foreign body.

H.  Treatment.

1.  Immediate referral to ophthalmologist.

I.  Follow up.

1.  Per ophthalmologist.

J.  Complications.
Impaired vision, 369.9

1.  More extensive ocular injury.

2.  Rebleeding, which may result in vision impairment.

K.  Education.

1.  Children sometimes take weeks for vision to return to normal.

2.  Prevention is best.

3.  Encourage parents to continue follow up as recommended by ophthalmologist.

XIV. OCULAR TRAUMA

A.  Definition.

Indirect or direct serious injury to eye.

B.  Etiology.

1.  Fireworks, sticks, stones, BB shots.

2.  Sports related.

C.  Occurrence.

1.  One-third of all causes of acquired blindness.

2.  Males > females 4:1.