Pediatric emergency medicine trisk 3675 3675

FIGURE 114.6 Patient shielded for right open-globe injury that was caused by a thrown pen.

Triage Considerations
Children with eye injuries associated with severe mechanisms, extreme pain,
significant eyelid swelling, or visual disturbance may have an open-globe injury.
These patients should undergo prompt evaluation in the ED with minimal
interventions.
Management
If an open-globe injury is suspected, no eye drops should be instilled. A shield
should be placed over the eye such that the edges contact the bony prominences
of the orbit above and below the globe ( Fig. 114.6 ). If a commercial shield is not
available, the clinician should cut off the bottom of a Styrofoam or plastic cup,
and use it as a shield, resting it against the bony prominences ( Fig. 114.7 ). For
multisystem trauma patients, a shield should even be placed over an obviously
injured eye while other resuscitative efforts are ongoing to prevent further
accidental injury or contamination by the medical staff. A patch does not provide
firm protection, may place pressure on the globe, and should not be used in this
circumstance.