Pediatric emergency medicine trisk 3666 3666

Assess Visual Acuity
The first step is to assess the visual acuity of both the injured and the unaffected
eye. The presence of bilaterally poor vision in a patient with unilateral eye trauma
suggests that the cause of the poor vision may be unrelated to the trauma.
Some patients may be unable to perform this task because of eye pain,
noncompliance, inability to open swollen lids, or obtundation from accompanying
head trauma. Even if the eyelids remain closed, the physician should test for light
perception. By shining a bright light in the direction of the globe through the
closed eyelid, the physician can ask the patient whether he or she perceives the
additional light on that side. A verbal acknowledgment or a reflex contraction of
the lids indicates light perception.
TABLE 114.1
TRAUMA INDICATIONS FOR EMERGENT CONSULTATION WITH
AN OPHTHALMOLOGIST
1. Definitive or suspected open-globe injury
2. Inability to open the eyelids to inspect the eye due to severe ocular trauma or
periocular injury
3. Visual disturbance related to ocular trauma
4. Hyphema
5. Extraocular movement disturbance
6. Foreign body not able to be removed
7. Absent red reflex
8. Papilledema
9. Retinal hemorrhages
If the patient is able to exhibit a greater degree of compliance, the examiner
may ask the patient to count fingers that are held at varying distances. The
maximum distance at which this task is completed should be noted on the chart
(e.g., counting fingers at 4 ft). If the patient is able to comply, the examiner
should obtain a visual acuity using a distance chart (see Chapter 123 Ophthalmic
Emergencies ). If the patient cannot stand but can identify letters or numbers, a
commercially available near visual acuity card, a smart-phone eye chart

application, or any other reading material may be used to assess near vision. This
testing has to be done at the appropriate distance from the patient’s eye; all near
vision cards will denote the testing distance for the calibrated visual acuity