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Pediatric Ocular Trauma: Recognition and Management (Trauma CME and Pharmacology CME) -

Pediatric Ocular Trauma: Recognition and Management (Trauma CME and Pharmacology CME)
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Publication Date: September 2022 (Volume 19, Number 9)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 09/01/2025.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME and 0.25 Pharmacology CME credits, subject to your state and institutional approval.


Ami P. Shah, MD, MPH
Faculty, Pediatric Emergency Medicine, University Medical Center Children’s Hospital of Nevada, Las Vegas, NV
Don Walker, MD
Pediatric Emergency Medicine Fellow, University of Nevada Las Vegas, Las Vegas, NV

Peer Reviewers

Tyler Ayalin, MD
Children's Health of Orange County, Department of Pediatric Emergency Medicine, Orange, CA
Asha Tharayil, MD, FAAP
Assistant Professor of Pediatrics, Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX


Ocular injuries are the most common cause of preventable blindness in children. A detailed and systematic evaluation of patients with ocular trauma will reduce morbidity and improve long-term vision outcomes. This issue reviews the critical aspects of the pediatric ocular examination for accurate diagnosis of vision-threatening injuries. It also provides recommendations for immediate emergency department treatment, and indications for urgent versus emergent ophthalmology referral.

Case Presentations

EMS is bringing in a previously healthy 3-year-old girl with a pencil lodged in her left eye...
  • The EMS provider does not report other injuries. He tells you the girl is awake, alert, and crying.
  • Her vital signs include a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, respiratory rate of 20 breaths/min, and oxygen saturation of 99% on room air. The EMS provider tells you that there are no focal neurological findings.
  • The EMS provider asks you whether they should attempt removal of the pencil and if you have any other recommendations.
A previously healthy 16-year-old boy presents to the ED after blunt eye trauma...
  • The boy was punched in the face by his brother. There was no loss of consciousness, vomiting, or other injuries. The patient complains of left eye swelling and blurry vision.
  • The physical examination is significant for left upper and lower eyelid edema and ecchymosis, and subconjunctival hemorrhage on the medial left globe. Extraocular movements are intact, his pupils are round and reactive to light, no hyphema is noted, and a nasal and oral examination is normal.
  • Your order a CT orbit that shows orbital wall fracture without entrapment.
  • You wonder whether you should consult ophthalmology for evaluation in the ED.
A healthy immunized 2-year-old girl presents to the ED after she spilled a bottle of household bleach on herself…
  • The mother noticed that the girl’s eyes were red and she was crying. The mother called poison control, who told her to rinse the girl’s eyes with water before going to the ED.
  • The child’s physical examination is unremarkable except for mild conjunctival injection bilaterally.
  • You wonder whether you should use a topical anesthetic. Should you re-irrigate the eyes? If so, what should the end-point of irrigation be?


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