Management of eye injuries in children attending the Emergency Department

Abstract

Paediatric eye injuries are the leading cause of monocular visual loss in children worldwide and are the most common eye-related emergency department visits [1,2].Ocular examination and management of eye injures in children can be very difficult and challenging [3,4].A local pilot study (TF Beattie, unpublished data) demonstrated variable practice in the management of eye injuries in children. We have followed this up with a convenience survey of emergency medicine clinicians attending a conference on emergency medicine.A total of 76 questionnaires were returned from physicians from 17 countries.Of all participants, 65 (85.5%) were working in a teaching hospital; and 53 (69.7%) regularly assessed children with eye injuries in their department.There were five main themes that emerged.First, there was inconsistency with regard to who saw and treated eye injuries in children. Of those who regularly assessed children in their department, only 18 reported to have protocols available. Moreover, of those participants who did not treat eye injuries in their department, ophthalmology opinion was obtained either via referral to the eye hospital, or by referral to the Ophthalmologist or by referral to the Paediatric Hospital. Ten participants reported not to have any arrangements for further assessment.Second, there was variation in the methods used for irrigation, especially the irrigant fluids. These included normal saline, Ringer's lactate solution and generic eye irrigation solution, with normal saline being used most commonly.Third, there was a plethora of drug therapy available and utilized for mydriasis. There was no consistent approach, with often multiple drugs available and used within single departments, including atropine, homatropine, cyclopentolate or tropicamide.Fourth, there were variations in the use of local anaesthetics. Again, there was no consistent approach resulting in the use of multiple drugs within single departments.These included tetracaine, oxybuprocaine and lidocaine. A quarter of participants was not aware which agent was used in their department.Finally, and particularly relevant in an era of increasing microbial resistance [5], there was again a wide variety of antibiotics available and utilized, again often within single departments. Chloramphenicol was used most commonly, followed by gentamicin, neomycin, polymixin and tobramycin. There was also a wide variation for the indication of antibiotic use with the most common conditions being abrasion, presence of foreign bodies, penetrating eye injuries, conjunctivitis and burns and chemical injuries.These five themes are united by the paucity of guidance or protocols within departments. We recognize that this is a convenience sample but the results are in keeping with the findings from our local audit. This suggests that a wider, structured review of management of paediatric eye trauma would be beneficial. If these findings were to be replicated it may be possible to investigate a guideline for management of eye trauma in children. Such an appr...