Pediatric emergency medicine trisk 4032 4032

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.