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CHAPTER 123 ■ OPHTHALMIC EMERGENCIES
DEBORAH SCHONFELD, BRUCE M. SCHNALL

GOALS OF EMERGENCY CARE
A wide variety of pediatric ocular complaints are first seen by clinicians in the
emergency room. A number of acute disorders such as ocular infections and
exposures of a toxic nature require the immediate diagnostic workup and
management that is best carried out in the emergency department (ED). While
many problems can, and should be, managed by the ED clinician alone, others
may require immediate or expedited ophthalmologic evaluation. The ED clinician
must be capable of conducting an ophthalmic history and physical examination to
accurately assess ocular complaints. This chapter discusses the approach to
ophthalmic emergencies commonly seen in the ED. Ocular trauma (including
injuries to the globe, cornea, and eyelids) is discussed in Chapter 114 Ocular
Trauma . The approach to several other common eye complaints is outlined in the
related chapters mentioned below.
KEY POINTS
The pediatric eye examination can be challenging and often requires
an age-adjusted approach.
It is critical to distinguish periorbital cellulitis from the much more
serious orbital cellulitis.

Patient age and associated symptoms can often help the clinician
differentiate between different types of conjunctivitis.
Copious ocular irrigation immediately following caustic exposure to the
eye can be vision-saving.
RELATED CHAPTERS


Signs and Symptoms
Eye: Red Eye: Chapter 27
Eye: Strabismus: Chapter 28
Eye: Unequal Pupils: Chapter 29
Eye: Visual Disturbances: Chapter 30
Medical, Surgical, and Trauma Emergencies
Infectious Disease Emergencies: Chapter 94
Ocular Trauma: Chapter 114
The Children’s Hospital of Philadelphia Clinical Pathway
Clinical Pathway for Patient With Suspected Preseptal or Orbital
Cellulitis
URL: />Authors: G. Binenbaum, MD; L. Lin, BS; I. Kuhn, CRNP; M. Russo, MD;
T. Kaur, MD; J. Lavelle, MD; M. Hayes, PharmD; W. Katowitz, MD; K.
Reddy, MD; M. Rizzi, MD; K. Revere, MD; A. Buzi, MD; M. Blackstone,
MD; C. Wilbur, MD; V. Scheid, MD
Posted: April 2019, last revised June 2019

EXAMINATION
Many children regard eye examinations and administration of eye drops with the
same fear that they harbor for injections. Therefore, it is important to gather as
much information as possible before touching the patient or instilling eye drops.
A detailed history can be a valuable tool in focusing the examination and making
a diagnosis. Questions regarding unilaterality/bilaterality, acute/chronic onset of

symptoms, and prior ophthalmic care are particularly helpful. For example, a
patient may be known to have an eye with poor vision, or to have had one eye
patched for a visual problem, suggesting amblyopia. Conversely, a child may be
unaware of having poor vision in one eye because the pediatric brain is able to
suppress the blurred image and focus solely on the clear image, allowing the child
to proceed with normal activity unaware of the unilateral visual deficit.
Importantly, an unremarkable visual screening examination at school does not
necessarily imply that the vision was normal because false-negative tests are well
known to occur.