Pediatric emergency medicine trisk 3676 3676

FIGURE 114.7 The bottom of a drinking cup is used as an eye shield.

Severe eye trauma may cause sedation or vomiting without concurrent head
injury. Crying and Valsalva maneuvers such as vomiting can result in further
extrusion of intraocular contents through the eye-wall opening. Every attempt
should be made to keep the child calm, including analgesia and antiemetic
medications. If inter-hospital transport is needed or if calming cannot be
achieved, tracheal intubation, sedation, and paralysis can be helpful to keep
intraocular pressures as low as possible.
Broad-spectrum intravenous antibiotic coverage is desirable, but this treatment
must be weighed against the potential aggravation of the child with intravenous
catheter placement. If an intraocular foreign body is suspected, the clinician must
establish by history whether it is metallic as this may influence the choice of
imaging and treatment. Even if an open-globe injury is not seen clearly on
examination, any patient who has a high-risk history, severe eyelid swelling, and
extreme resistance to examination should be given an eye shield and referred to
an ophthalmologist as if an open-globe injury was confirmed.

BLOW-OUT FRACTURE