Clinical Pathways
Clinical Pathways
No chemical burn
No chemical burn

No chemical burn

View The Full Pathway

Decision

Is a globe injury suspected?

Yes

  • Stop examination 
  • Give patient a rigid eye shield (Class III) 
  • Obtain imaging (Class II) 
  • Provide tetanus prophylaxis (Class II) 
  • Administer IV antibiotics (Class II) 
  • Obtain ophthalmology consult (Class II)

Background

Patients with an open globe injury will present with significant pain and decreased visual acuity. Physical examination findings include, teardrop (see Figure 11) or irregular pupil, prolapsed iris, iridodialysis (Figure 12, page 16) lacerations, hyphema, extensive subconjunctival hemorrhage, and chemosis. These injuries present a high risk for significant morbidity in terms of vision loss and complications such as post-traumatic endophthalmitis and should be treated promptly. Emergent ophthalmology consultation should be obtained for any open/ruptured globe. should be obtained for any open/ruptured globe. The goal of initial management is to keep the patient as calm as possible to prevent increase in the intraocular pressure. The pain and vision loss in open globe injuries can be very disquieting for patients, leading to agitation and potentially worse outcomes, so attempt to keep the patient as comfortable as possible. Child Life specialists, if available, can be very helpful in improving outcomes.

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References
  1. Archambault C, Mekliche A, Isenberg J, et al. Pediatric ocular injuries: a 3-year follow-up study of patients presenting to a tertiary care clinic in Canada. J Pediatr Health Care.2020;57(3):185-189. (Retrospective chart review; 409 patients)
  2. Boret C, Brehin C, Cortey C, et al. Pediatric ocular trauma: characteristics and outcomes among a French cohort (2007-2016). Arch Pediatr. 2020;27(3):128-134. (Retrospective observational study; 337 patients)
  3. Ferguson RA, Sung J, McKelvie J. New Zealand childhood ocular trauma study: analysis of 75 601 cases of ocular injury from 2007 to 2016. Clin Exp Ophthalmol. 2019;47(6):718-725. (Retrospective observational study; 75,601 cases)
  4. Gise R, Truong T, Parsikia A, et al. A comparison of pediatric ocular injuries based on intention in patients admitted with trauma. BMC Ophthalmol. 2019;19(1):37. (Retrospective chart review; 58,765 patients)
  5. Jolly R, Arjunan M, Theodorou M, et al. Eye injuries in children - incidence and outcomes: an observational study at a dedicated children’s eye casualty. Eur J Ophthalmol. 2019;29(5):499-503. (Retrospective chart review; 508 patients)
  6. Matsa E, Shi J, Wheeler KK, et al. Trends in US emergency department visits for pediatric acute ocular injury. JAMA Ophthalmol. 2018;136(8):895-903. (Retrospective cohort study; 376,040 patients)
  7. Jonas DE, Amick HR, Wallace IF, et al. Vision screening in children aged 6 months to 5 years: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;318(9):845-858. (Systematic review; 40 studies)
  8. Pieramici DJ, Sternberg P, Aaberg TM Sr, et al. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group. Am J Ophthalmol.1997;123(6):820-831. (Clinical practice guidelines)
  9. Messman AM. Ocular injuries: new strategies in emergency department management. Emerg Med Pract. 2015;17(11):1-21. (Review)
  10. Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am.2002;15(2):139-143 (Review)
  11. Kuhn F, Morris R, Witherspoon CD, et al. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240-243. (Review)
  12. Miller KN, Collins CL, Chounthirath T, et al. Pediatric sports- and recreation-related eye injuries treated in US emergency departments. Pediatrics. 2018;141(2):e201730833. (Observational study; 441,800 patients)
  13. Xiang H, Stallones L, Chen G, et al. Work-related eye injuries treated in hospital emergency departments in the US. Am J Ind Med. 2005;48(1):57-62. (Observational study; 280,000 patients)
  14. Breazzano MP, Day HR, Tanaka S, et al. Prospective analysis of pediatric ocular chemical burns: laundry detergent pods. J AAPOS. 2018;22(6):426-428. (Observational study; 12 patients)
  15. Hink EM, Oliver SC, Drack AV, et al. Pediatric golf-related ophthalmic injuries. Arch Opthalmol. 2008;126(9):1252-1256. (Retrospective case series; 11 patients)
  16. Jones M, Kistamgari S, Smith GA. Nonpowder firearm injuries to children treated in emergency departments. Pediatrics. 2019;144(6):e20192739. (Retrospective analysis; 360,133 patients)
  17. Lee R, Fredrick D. Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012. J AAPOS. 2015;19(2):163-168.e161. (Retrospective analysis; 3161 patients)
  18. McLoughlin RJ, Stetson A, Green J, et al. Toy guns, real danger: an update on pediatric injury patterns related to nonpowder weapons. J Pediatr Surg. 2020;55(1):146-152. (Cross-sectional analysis; 1028 patients)
  19. Prickett AL, Salar S, Chow CC, et al. Traumatic eye injuries from collapsible wire laundry hampers. Pediatrics. 2013;132(2):522. (Case series; 2 patients)
  20. Subramaniam S, Pudpud AA, Rutman MS. Fishhook injury to the eyelid: case report and review of removal methods. Pediatr Emerg Care. 2015;31(3):209-213. (Case report)
  21. Veenstra M, Prasad J, Schaewe H, et al. Nonpowder firearms cause significant pediatric injuries. J Trauma Acute Care Surg. 2015;78(6):1138-1142. (Retrospective chart review; 303 patients)
  22. Turvey TA, Golden BA. Orbital anatomy for the surgeon. Oral Maxillofac Surg Clin North Am. 2012;24(4):525-536. (Review)
  23. Bogie AL, Bogie CP III. Pediatric ocular trauma: a clinical perspective. Pediatr Emerg Med Rep. 2018;23(12). (Review)
  24. Rocha KM, Martins EN, Melo LAS Jr, et al. Outpatient management of traumatic hyphema in children: prospective evaluation. J AAPOS. 2004;8(4):357-361. (Perspective case series; 35 patients)
  25. Johnson JJ, Kester N, Davies B. Traumatic eye emergencies. In: Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Strange and Schafermeyer’s Pediatric Emergency Medicine.5th ed. McGraw-Hill Education; 2019. (Book chapter)
  26. Fleming S, Dooley I, Cullinane A. Ocular chemical burns in a paediatric population. Ir Med J. 2013;106(7):219-220. (Journal editorial comment)
  27. Kuckelkorn R, Schrage N, Keller G, et al. Emergency treatment of chemical and thermal eye burns. Acta Ophthalmol Scand. 2002;80(1):4-10. (Review) DOI: 10.1034/j.1600-0420.2002.800102.x
  28. Levin AV. Eye emergencies: acute management in the pediatric ambulatory care setting. Pediatr Emerg Care. 1991;7(6):367-377. (Review)
  29. Schabowski S, Alcala C. Eye examination. In: Reichman EF ed. Reichman's Emergency Medicine Procedures. 3rd ed. McGraw-Hill Education; 2019. (Book chapter)
  30. Lecuona K. Assessing and managing eye injuries. Community Eye Health.2005;18(55):101-104. (Review)
  31. Salvin JH. Systematic approach to pediatric ocular trauma. Curr Opin Ophthalmol.2007;18(5):366-372. (Review)
  32. Wallace DK, Morse CL, Melia M, et al. Pediatric eye evaluations preferred practice pattern: I. Vision screening in the primary care and community setting; II. Comprehensive ophthalmic examination. Ophthalmology. 2018;125(1):P184-P227. (Review)

    33. ®

  33. Caltrider D, Gupta A, Tripathy K. Evaluation of visual acuity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. February 2022. (Review)
  34. Di Foggia E, Stoll N, Meunier H, et al. A new visual acuity test on touchpad for vision screening in children. Int J Ophthalmol. 2020;13(9):1436-1442. (Observational cohort study; 101 patients)
  35. Donahue SP, Baker CN, Committee on Practice and Ambulatory Medicine, American Academy of Pediatrics, et al. Procedures for the evaluation of the visual system by pediatricians. Pediatrics. 2016;137(1):e20153597. (Clinical report) DOI: 10.1542/peds.2015-3597
  36. Merrill K. Don’t miss this! Red flags in the pediatric eye examination: subnormal acuity. J Binocul Vis Ocul Motil. 2019;69(3):90-92. (Review)
  37. Myuran T. Improving visual assessment documentation in patients with periorbital trauma through an eye assessment teaching session and a proforma sticker. BMJ Qual Improv Rep. 2017;6(1):u211253.w4618. (Cohort studies; 38 patients)
  38. Nanda KD, Blaha B, Churchfield WT, et al. Induced tropia test and visual acuity testing in nonverbal children. J Binocul Vis Ocul Motil. 2018;68(4):134-136. (Cohort study; 34 patients)
  39. Zhao L, Stinnett SS, Prakalapakorn SG. Visual acuity assessment and vision screening using a novel smartphone application. J Pediatr. 2019;213:203-210.e1. (Cohort study; 111 patients)
  40. Prentiss KA, Dorfman DH. Pediatric ophthalmology in the emergency department. Emerg Med Clin North Am. 2008;26(1):181-198. (Review)
  41. Loh AR, Chiang MF. Pediatric vision screening. Pediatr Rev. 2018;39(5):225-234. (Review)
  42. Burroughs JR, Anderson RL, Patrinely JR, et al. Preoperative assessment of the eye and periocular region. Semin Plast Surg. 2007;21(1):5. (Review)
  43. Committee on Practice and Ambulatory Medicine, Section on Ophthalmology. American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Eye examination in infants, children, and young adults by pediatricians. Pediatrics. 2003;111(4 Pt 1):902-907. (Expert committee review)
  44. Robinett DA, Kahn JH. The physical examination of the eye. Emerg Med Clin North Am.2008;26(1):1-16. (Review article)
  45. Trief D, Adebona OT, Turalba AV, et al. The pediatric traumatic hyphema. Int Ophthalmol Clin. 2013;53(4):43-57. (Review) DOI: 10.1097/IIO.0b013e3182a129fd
  46. Marsden J. How to examine an eye. Nurs Stand. 2015;30(13):34-37. (Review)
  47. Gupta B, Sian I, Agrawal R. Ophthalmic trauma: risk and management update. Expert Rev Ophthalmol. 2014;9(4):315-329. (Expert review)
  48. Coon D, Yuan N, Jones D, et al. Defining pediatric orbital roof fractures: patterns, sequelae, and indications for operation. Plast Reconstr Surg. 2014;134(3):442e-448e. (Observational study; 1484 patients)
  49. Hink EM, Wei LA, Durairaj VD. Clinical features and treatment of pediatric orbit fractures. Ophthalmic Plast Reconstr Surg. 2014;30(2):124-131. (Retrospective case series; 312 patients)
  50. Lane K, Penne RB, Bilyk JR. Evaluation and management of pediatric orbital fractures in a primary care setting. Orbit. 2007;26(3):183-191. (Retrospective chart review; 14 patients)
  51. Bveau AP, Somani AN, Dossani RH. Pupillary light reflex. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. July 2021. (Review)
  52. Christian CW, Levin AV, Council on Child Abuse and Neglect, et al. The eye examination in the evaluation of child abuse. Pediatrics. 2018;142(2):e20181411. (Review)
  53. Lee J-S. Slit lamp exam. In: Lee J-Sed. Primary Eye Examination. Springer;2019:101-111. (Book Chapter)
  54. Ager L. Optical services for visually impaired children. Community Eye Health.1998;11(27):38-40. (Review)
  55. Beal C, Giordano B. Clinical evaluation of red eyes in pediatric patients. J Pediatr Health Care. 2016;30(5):506-514. (Review)
  56. Wipperman JL, Dorsch JN. Evaluation and management of corneal abrasions. Am Fam Physician. 2013;87(2):114-120. (Review)
  57. Campbell TD, Gnugnoli DM. Seidel test. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. December 2021. (Review)
  58. Abelson MB, Udell IJ, Weston JH. Normal human tear pH by direct measurement. Arch Opthalmol. 1981;99(2):301. (Prospective observational study; 44 patients)
  59. Saidinejad M, Burns MM. Ocular irrigant alternatives in pediatric emergency medicine. Pediatr Emerg Care. 2005;21(1):23-26. (Review)
  60. Marin JR, Lewiss RE. Point-of-care ultrasonography by pediatric emergency medicine physicians. Pediatr Emerg Care. 2015;31(7):525. (Review)
  61. Boniface KS, Aalam A, Salimian M, et al. Trauma-induced bilateral ectopia lentis diagnosed with point-of-care ultrasound. J Emerg Med. 2015;48(6):e135-e137. (Case report)
  62. Frasure SE, Saul T, Lewiss RE. Bedside ultrasound diagnosis of vitreous hemorrhage and traumatic lens dislocation. Am J Emerg Med. 2013;31(6):1002.e1-1002.e2. (Case report)
  63. Riggs BJ, Trimboli-Heidler C, Spaeder MC, et al. The use of ophthalmic ultrasonography to identify retinal injuries associated with abusive head trauma. Ann Emerg Med.2015;67(5):620-624. (Review)
  64. Ben-Yakov M, Desjardins M-P, Fischer JWJ. Emergency point-of-care ultrasound detection of papilledema in the pediatric emergency department. Pediatr Emerg Care.2015;31(11):766-770. (Case series; 4 patients)
  65. Seguin J, Le C-K, Fischer JW, et al. Ocular point-of-care ultrasound in the pediatric emergency department. Pediatr Emerg Care. 2019;35(3):E53-E58. (Case series; 6 patients)
  66. Tsung JW, Blaivas M, Cooper A, et al. A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care. 2005;21(2):94-98. (Case series; 3 patients)
  67. Kniess CK, Fong TC, Reilly AJ, et al. Early detection of traumatic retrobulbar hemorrhage using bedside ocular ultrasound. J Emerg Med. 2015;49(1):58-60. (Case report)
  68. Berrocal T, de Orbe A, Prieto C, et al. US and color Doppler imaging of ocular and orbital disease in the pediatric age group. Radiographics. 1996;16(2):251-272. (Review)
  69. Silva CT, Brockley CR, Crum A, et al. Pediatric ocular sonography. Semin Ultrasound CT MR. 2011;32(1):14-27. (Review)
  70. Endo Y. Ultrasound assessment of extraocular movements and pupillary light reflex in ocular trauma. Ultrasound Quarterly. 2011;27(1):63-64. (Review)
  71. Mirjalili H, Ali RE, Yazdiyousefi Y, et al. The value of ultrasonography in determining pupillary light reflex in patients with traumatic ocular injuries; a letter to editor. Arch Acad Emerg Med. 2019;7(1):e62. (Letter to editor)
  72. Ojaghihaghighi S, Lombardi KM, Davis S, et al. Diagnosis of traumatic eye injuries with point-of-care ocular ultrasonography in the emergency department. Ann Emerg Med.2019;74(3):365-371. (Prospective cohort study; 232 patients)
  73. Forbes BJ, Goldstein SM. Ocular trauma in infancy and childhood. In: Albert D, Miller J, Azar D, et al, eds. Albert & Jakobiec’s Principles & Practice of Ophthalmology. 2008:4263-4269. (Book chapter)
  74. Kubal WS. Imaging of orbital trauma. Radiographics. 2008;28(6):1729-1739. (Review)
  75. Chandler DB, Rubin PA. Developments in the understanding and management of pediatric orbital fractures. Int Ophthalmol Clin. 2001;41(4):87-104. (Review)
  76. Kim G, Wong M. Ocular trauma an evidence based approach to evaluation and management in the ED. Pediatr Emerg Med Pract. 2006;3(11):1-16. (Review)
  77. Criden MR, Ellis FJ. Linear nondisplaced orbital fractures with muscle entrapment. J AAPOS. 2007;11(2):142-147. (Case series; 12 patients)
  78. Parbhu KC, Galler KE, Li C, et al. Underestimation of soft tissue entrapment by computed tomography in orbital floor fractures in the pediatric population. Ophthalmology.2008;115(9):1620-1625. (Retrospective observational case series; 55 patients)
  79. Cohen SM, Garrett CG. Pediatric orbital floor fractures: nausea/vomiting as signs of entrapment. Otolaryngol Head Neck Surg. 2003;129(1):43-47. (Retrospective chart review; 29 patients)
  80. Hack KM, Pedersen R. Mental status changes and bradycardia: don’t forget the eye! Traumatic hyphema can mimic increased intracranial pressure. Clin Pediatr.2009;48(3):331-333. (Case report)
  81. Barh A, Swaminathan M, Mukherjee B. Orbital fractures in children: clinical features and management outcomes. J AAPOS. 2018;22(6):415.e411-415.e417. (Retrospective case series; 52 patients)
  82. Calder L, Balasubramanian S, Stiell I. Lack of consensus on corneal abrasion management: results of a national survey. Can J Emerg Med. 2004;6(6):402-407. (National consensus survey; 470 participants)
  83. Wakai A, Lawrenson JG, Lawrenson AL, et al. Topical non-steroidal anti-inflammatory drugs for analgesia in traumatic corneal abrasions. Cochrane Database Syst Rev.2017;5:CD009781. (Systematic review)
  84. West JR. Are topical nonsteroidal anti-inflammatory drugs useful for analgesia in patients with traumatic corneal abrasions? Ann Emerg Med. 2019;73(2):157-159. (Review)
  85. Browner EA. Corneal abrasions. Pediatr Rev. 2012;33(6):285-286. (Review article)
  86. Lee MD, Driver TH, Seitzman GD. Cornea specialists do not recommend routine usage of topical anesthetics for corneal abrasions. Ann Emerg Med. 2019;74(3):463-466. (Review)
  87. Waldman N, Densie IK, Herbison P, et al. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014;21(4):374-382. (Randomized controlled trial)
  88. Lim CHL, Turner A, Lim BX. Patching for corneal abrasion. Cochrane Database Syst Rev.2016;2016(7):CD004764. (Systematic review; 12 trials, 1080 participants)
  89. Ahmed F, House RJ, Feldman BH. Corneal abrasions and corneal foreign bodies. Prim Care. 2015;42(3):363-375. (Review)
  90. Shetler J, Lighthizer N. Foreign body removal in 12 steps.(Essential procedures at the slit lamp). Rev Optometry. 2015;152(1):22. (Procedure review)
  91. Upshaw JE, Brenkert TE, Losek JD. Ocular foreign bodies in children. Pediatr Emerg Care. 2008 Jun;24(6):409-14 (Review)
  92. Chau JPC, Lee DTF, Lo SHS. A systematic review of methods of eye irrigation for adults and children with ocular chemical burns. Worldviews Evid Based Nurs. 2012;9(3):129-138. (Systematic review; 4 studies, 302 patients)
  93. Ratnapalan S, Das L. Causes of eye burns in children. Pediatr Emerg Care. 2011;27(2):151-156. (Systematic review)
  94. Baradaran-Rafii A, Eslani M, Haq Z, et al. Current and upcoming therapies for ocular surface chemical injuries. Ocul Surf. 2016;15(1):48-64. (Review)
  95. Eslani M, Alireza B-R, Movahedan A, et al. The ocular surface chemical burns. J Ophthalmol. 2014;2014(1):196827-196829. (Review)
  96. Ilhan A, Yolcu U. Comment on “The ocular surface chemical burns”. J Ophthalmol. 2015;2015:541512. (Editorial comment)
  97. Scott WJ, Schrage N, Dohlman C. Emergency eye rinse for chemical injuries: new considerations. JAMA Ophthalmol. 2015;133(3):245. (Review)
  98. Soleimani M, Naderan M. Management strategies of ocular chemical burns: current perspectives. Clin Ophthalmol. 2020;14:2687-2699. (Review article)
  99. Wiesner N, Dutescu RM, Uthoff D, et al. First aid therapy for corrosive chemical eye burns: results of a 30-year longitudinal study with two different decontamination concepts. Graefes Arch Clin Exp Ophthalmol. 2019;257(8):1795-1803. (Retrospective cohort study)
  100. Catalano RA. Eye injuries and prevention: pediatric ophthalmology. Pediatr Clin North Am. 1993;40(4):827-839. (Review)
  101. Lim LT, Ah-Kee E, Collins CE. Common eye drops and their implications for pH measurements in the management of chemical eye injuries. Int J Ophthalmol.2014;7(6):1067-1068. (Letter to editor)
  102. Nguyen ATM, Chamberlain K, Holland AJA. Paediatric chemical burns: a clinical review. Eur J Pediatr. 2021;180(5):1359-1369. (Review)
  103. Scott R. The injured eye. Philos Trans R Soc Lond B Biol Sci. 2011;366(1562):251-260. (Review)
  104. Sharma N, Kaur M, Agarwal T, et al. Treatment of acute ocular chemical burns. Surv Ophthalmol. 2018;63(2):214-235. (Review)
  105. Shi W, Li S. Chemical injuries of the cornea. In: Ocular Emergency. Springer Singapore; 2018:215-232. (Review)
  106. Boese EA, Karr DJ, Chiang MF, et al. Visual acuity recovery following traumatic hyphema in a pediatric population. J AAPOS. 2018;22(2):115-118. (Retrospective chart review; 55 patients)
  107. Gragg J, Blair K, Baker MB. Hyphema. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. May 2022. (Review)
  108. SooHoo JR, Davies BW, Braverman RS, et al. Pediatric traumatic hyphema: a review of 138 consecutive cases. J AAPOS. 2013;17(6):565-567. (Retrospective cohort; 138 patients) DOI: 10.1016/j.jaapos.2013.07.007
  109. McCallum E, Keren S, Lapira M, et al. Orbital compartment syndrome: an update with review of the literature. Clin Ophthalmol (Auckland, N.Z.). 2019;13:2189-2194. (Review)
  110. Crouch ER Jr, Crouch ER. Management of traumatic hyphema: therapeutic options. J Pediatr Ophthalmol Strabismus. 1999;36(5):238-250. (Review)
  111. Richards MD, Barnes K, Yardley A-ME, et al. Traumatic hyphaema in children: a retrospective and prospective study of outcomes at an Australian paediatric centre. BMJ Open Ophthalmol. 2019;4(1):e000215. (Retrospective and prospective cohort study; 98 patients)
  112. Recchia FM, Saluja RK, Hammel K, et al. Outpatient management of traumatic microhyphema. Ophthalmology. 2002;109(8):1465-1470. (Retrospective cohort; 162 patients)
  113. Mir T, Iftikhar M, Seidel N, et al. Clinical characteristics and outcomes of hyphema in patients with sickle cell trait: 10-year experience at the wilmer eye institute. Clin Ophthalmol. 2020;14:4165-4172. (Retrospective cohort; 17 patients)
  114. Nasrullah A, Kerr NC. Sickle cell trait as a risk factor for secondary hemorrhage in children with traumatic hyphema. Am J Ophthalmol. 1997;123(6):783-790. (Retrospective cohort study; 97 patients)
  115. Aquino LM, Ranche FK. Hemophilia presenting as recurrent ocular hemorrhage. GMS Ophthalmol Cases. 2020;10:Doc15. (Case report)
  116. Belviranli S, Ozkagnici A, Tokgoz H, et al. Traumatic hyphema in a patient with severe hemophilia A: clinical features and management. Eur J Ophthalmol. 2021;31(2):NP106-NP108. (Case report)
  117. Marcus M, Biedner B, Lifshitz T, et al. Aspirin and secondary bleeding after traumatic hyphema. Ann Ophthalmol. 1988;20(4):157-158. (Randomized controlled study; 51 patients)
  118. Swaminathan A, Otterness K, Milne K, et al. The safety of topical anesthetics in the treatment of corneal abrasions: a review. J Emerg Med. 2015;49(5):810-815. (Systematic review)
  119. Deans R, Noel LP, Clarke WN. Oral administration of tranexamic acid in the management of traumatic hyphema in children. Can J Ophthalmol. 1992;27(4):181-183. (Prospective study; 163 patients)
  120. Gharaibeh A, Savage HI, Scherer RW, et al. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev. 2019;1(1):CD005431. (Cochrane review; 27 studies, 2643 participants)
  121. Albiani DA, Hodge WG, Pan YI, et al. Tranexamic acid in the treatment of pediatric traumatic hyphema. Can J Ophthalmol. 2008;43(4):428-431. (Retrospective cohort study; 137 patients)
  122. Gerstenblith AT, Rabinowitz MP. Traumatic iritis. In: Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. Wolters Kluwer; 2009:21-25. (Book chapter)
  123. Doan A. Tear drop pupil. EyeRounds Online Atlas of Ophthalmology. Accessed August 1, 2022. (Online textbook)
  124. Caccamise WC Sr. Iridodialysis. EyeRounds Online Atlas of Ophthalmology. Accessed August 1, 2022. (Online textbook)
  125. Al-Omran A, Abboud EB, Abu El-Asrar AM. Microbiologic spectrum and visual outcome of posttraumatic endophthalmitis. Retina. 2007;27(2):236-242. (Cross-sectional study; 67 patients)
  126. Li X, Zarbin MA, Bhagat N. Pediatric open globe injury: a review of the literature. J Emerg Trauma Shock. 2015;8(4):216-223. (Review)
  127. Li X, Zarbin MA, Langer PD, et al. Posttraumatic endophthalmitis: an 18-year case series. Retina. 2018;38(1):60-71. (Case series; 26 patients)
  128. Winterton JV, Patel K, Mizen KD. Review of management options for a retrobulbar hemorrhage. J Oral Maxillofac Surg. 2007;65(2):296-299. (Review)
  129. Amer E, El-Rahman Abbas A. Ocular compartment syndrome and lateral canthotomy procedure. J Emerg Med. 2019;56(3):294-297. (Case report)
  130. Chung SY, Langer PD. Pediatric orbital blowout fractures. Curr Opin Ophthalmol.2017;28(5):470-476. (Review)
  131. Mahon BM, Desai BK. Lateral canthotomy. In: Atlas of Emergency Medicine Procedures. Springer; 2016:305-308. (Book chapter)
  132. Raman P. Retrobulbar hemorrhage in a child an ophthalmic emergency. MSO Meeting 2014. Accessed on August 1, 2022. (Case report)
  133. Murali S, Davis C, McCrea MJ, et al. Orbital compartment syndrome: pearls and pitfalls for the emergency physician. J Am Coll Emerg Physicians Open. 2021;2(2):e12372. (Review)
  134. Raikin J, Hall RV, Papanagnou D. “Trauma to the eye”-a low fidelity resident teaching module for identifying and treating a retrobulbar hematoma. MedEdPORTAL.2021;17:11075. (Cohort study)
  135. Suner S, Simmons W, Savitt DL. A porcine model for instruction of lateral canthotomy. Acad Emerg Med. 2000;7(7):837-838. (Cohort study; 22 participants)
  136. Hallet C, Willoughby C, Shafiq A, et al. Pitfalls in the management of a child with mild haemophilia A and a traumatic hyphaema. Haemophilia. 2000;6(2):118-119. (Case report)
  137. Shatnawi R, Shweiki SA, Khan AO. Bilateral simultaneous orbital hemorrhage and compartment syndrome as the presenting sign of acquired hemophilia A in an 11-year-old girl. J AAPOS. 2020;24(2):124-126. (Case report)
  138. Srivastava A, Brewer AK, Mauser-Bunschoten E, et al. Guidelines for the management of hemophilia. Haemophilia. 2013;19(1):e1-e47. (Review article)
  139. Wilker SC, Singh A, Ellis FJ. Recurrent bleeding following traumatic hyphema due to mild hemophilia B (Christmas disease). J AAPOS. 2007;11(6):622-623. (Case report)
  140. Mowatt L, Chambers C. Ocular morbidity of traumatic hyphema in a Jamaican hospital. Eur J Ophthalmol. 2010;20(3):584-589. (Cohort study; 44 patients)
  141. Bansal S, Gunasekeran DV, Ang B, et al. Controversies in the pathophysiology and management of hyphema. Surv Ophthalmol. 2015;61(3):297-308. (Review)
  142. Harkness MJ. Corneal abrasion in infancy as a cause of inconsolable crying. Pediatr Emerg Care. 1989;5(4):242-244. (Case report)
  143. Allister L, Ruest S. A systematic approach to the evaluation of acute unexplained crying in infants in the emergency department. Pediatr Emerg Med Pract. 2014;11(3):1-17. (Review)
  144. Chua C, Setlik J, Niklas V. Emergency department triage of the “incessantly crying” baby. Pediatr Ann. 2016;45(11):e394-e398. (Review)
  145. Freedman SB, Al-Harthy N, Thull-Freedman J. The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics. 2009;123(3):841-848. (Retrospective review; 237 patients)
  146. Shah VD, Uddaraju M, Singh A, et al. Clinical profile, etiology, and outcome of infantile ocular trauma: a developing country perspective. Pediatr Emerg Care. 2019;35(8):558-560. (Retrospective chart review; 76 patients)
  147. Shope TR, Rieg TS, Kathiria NN. Corneal abrasions in young infants. Pediatrics.2010;125(3):565. (Cohort study; 96 patients)
  148. Ross M, Deschênes J. Practice patterns in the interdisciplinary management of corneal abrasions. Can J Ophthalmol. 2017;52(6):548-551. (Retrospective chart review; 90 patients)
  149. Wong MM, Anninger W. The pediatric red eye. Pediatr Clin North Am. 2014;61(3):591-606. (Review)
  150. Halstead SM, Deakyne SJ, Bajaj L, et al. The effect of ketamine on intraocular pressure in pediatric patients during procedural sedation. Acad Emerg Med. 2012;19(10):1145-1150. (Prospective non-inferiority study; 80 patients)
  151. Nagdeve NG, Yaddanapudi S, Pandav SS. The effect of different doses of ketamine on intraocular pressure in anesthetized children. J Pediatr Ophthalmol Strabismus. 2006;43(4):219-223. (Randomized controlled trial; 45 patients)
  152. Jasien JV, Girkin CA, Downs JC. Effect of anesthesia on intraocular pressure measured with continuous wireless telemetry in nonhuman primates. Invest Ophthalmol Vis Sci.2019;60(12):3830-3834. (Animal study)
  153. Benson WH, Snyder IS, Granus V, et al. Tetanus prophylaxis following ocular injuries. J Emerg Med. 1993;11(6):677-683. (Review)
  154. Mukherjee P, Sivakumar A, Mackway-Jones K. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003;20(1):62-64. (Review)
  155. Fusco N, Stead TG, Lebowitz D, et al. Traumatic corneal abrasion. Cureus. 2019;11(4):e4396. (Review)
  156. Smith CH, Goldman RD. Topical nonsteroidal anti-inflammatory drugs for corneal abrasions in children. Can Fam Physician. 2012;58(7):748-749. (Review)
  157. Yu CW, Kirubarajan A, Yau M, et al. Topical pain control for corneal abrasions: a systematic review and meta-analysis. Acad Emerg Med. 2021. (Systematic review)
  158. Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology.Surv Ophthalmol. 2010;55(2):108-133. (Review)
  159. Shipman S, Painter K, Keuchel M, et al. Short-term topical tetracaine is highly efficacious for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Ann Emerg Med. 2021;77(3):338-344. (Randomized control trial; 118 patients)
  160. Judge AJ, Najafi K, Lee DA, et al. Corneal endothelial toxicity of topical anesthesia. Ophthalmology. 1997;104(9):1373-1379. (Animal study)
  161. Pathipati AS, Wood EH, Lam CK, et al. Visual acuity measured with a smartphone app is more accurate than Snellen testing by emergency department providers. Graefes Arch Clin Exp Ophthalmol. 2016;254(6):1175-1180. (Randomized controlled trial; 128 patients)
  162. Hatton MP, Thakker MM, Ray S. Orbital and adnexal trauma associated with open-globe injuries. Ophthalmic Plast Reconstr Surg. 2002;18(6):458-461. (Retrospective chart review; 300 patients)

Globe injury unlikely
Globe injury unlikely
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