Accidental trauma in children

Chapter 66 Accidental trauma in children


The number of serious eye injuries in children has been estimated at 11.8 per 100 000 per year.1 At least 35% of serious eye injuries occur in children; the majority occur in children under the age of 12.2 Eye injuries account for 8–14% of total injuries in children3 and are the most common cause of unilateral blindness in children. Aside from vision loss, significant disfigurement may accompany a serious eye injury. Several factors place a child at risk for serious accidental eye injury:4 age between 0 and 5 years, male gender, and a lack of parental supervision. Non-compliance with optical correction and patching is an important factor after childhood perforating anterior eye injury.5 Amblyopia may limit recovery of vision in children under 7 years of age, even in eye injuries that would carry a good prognosis in older individuals.

Ophthalmic trauma caused by amniocentesis and birth injury

Eye injuries occur in association with amniocentesis (Fig. 66.1). Of five cases of presumed ophthalmic amniocentesis injury,6 one had a hemianopia and gaze palsy, two had presumed needle perforation of the eye resulting in a peaked pupil in one case and chorioretinal scar in the other. In the remaining two one showed a small leukoma, and one a limbal scar. After amniocentesis, non-pigmented anterior iris cysts adherent to the posterior cornea and with peripheral anterior synechiae are possibly a result of injury with the amniocentesis needle. Congenital aphakia with retinal scar has also been described following in utero perforation of the globe.

Ocular adnexal injuries occur, albeit rarely, after episiotomy. The possibility of ruptured globe caused by childbirth is discussed below. Forceps should be suspected as the cause of a congenital corneal abnormality in which vertical ruptures in Descemet’s membrane (Fig. 66.2) occur with a contralesional occipital depression caused by the other arm of the forceps (Chapter 33).

Eyelid and lacrimal system trauma

In eyelid margin laceration, careful reapproximation of the margins of the eyelid is essential. The etiology is sharp or blunt trauma to the lid margin. Injuries to the canalicular system will occur if the medial eyelid margin is injured, either of the upper or lower lid commonly caused in children by dog bites.7 They require intubation with silastic tubing passed through both ends of the canaliculus and into the nose or the use of a monocanalicular stent. With deeper injuries, we close deep edges of the wound with fine grade absorbable suture and close the more superficial edges of the wound with fine suture. With dog bite injuries additional problems may be an inferior oblique palsy or restrictive type of ocular motor problem. We close the laceration, as described above, followed later by strabismus management as required.

Anterior segment trauma

Eye wall injuries

Predisposition (“brittle corneas”)

Certain eyes may be more likely to rupture with relatively minor trauma. In Ehlers-Danlos syndrome, defective collagen cross-linkage leads to scleral and corneal weakness (Fig. 66.8); in Ehlers-Danlos with blue sclera (due to scleral thinning), hyperextensible skin, and hypermobile joints, spontaneous corneal rupture can occur, and in the brittle cornea, blue sclera and joint hyperextensibility syndrome, spontaneous rupture of the globe may occur. Such patients may have red hair and develop keratoglobus, and, unlike Ehlers-Danlos syndrome, they have normal levels of lysyl hydroxylase. Osteogenesis imperfecta consists of blue sclera, deafness, and bone fractures. Children with this syndrome may also be more prone to corneal rupture from minor trauma.

Jun 4, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Accidental trauma in children

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