Ocular trauma and chemical injury

Overview & Definition

Picture a seven-year-old who runs in from the kitchen clutching his eye after a dishwasher tablet burst, and a ten-year-old hit in the eye by a dart. Both are screaming, both eyes are firmly shut, and in both cases the temptation is to prise the lids apart and examine. That instinct is right for one and dangerous for the other — and telling them apart is the whole skill of paediatric ocular trauma. For the chemical splash, the first thing you do is irrigate, because every minute of retained alkali destroys limbal stem cells. For the dart, the first thing you do is shield, because pressing a full-thickness wound extrudes the contents of the eye. Everything else — the classification, score, surgery — follows from getting those two first moves right. [5] [8]

Ocular trauma means any mechanical, chemical or physical injury to the eye and its adnexa. In children it is common, it is frequently preventable, and it remains a leading cause of non-congenital unilateral blindness because the developing visual system is unforgiving: a scarred cornea, a deprived retina or a neglected injury all seed amblyopia as well as structural damage. [8] [10] The clinical task is layered. The first layer is first aid — irrigate the chemical injury, shield the open globe. The second layer is recognition — naming the injury in the standardised BETT language so that it is communicated the same way to the ophthalmologist. The third layer is prognosis and definitive care — the Ocular Trauma Score, the chemical-burn grade, and the surgical and follow-up pathway. [1] [3]