This chapter discusses common eye injuries and disorders associated with infancy and childhood.
Myelination of the optic nerve is not complete until the infant’s eyes have been exposed to light for approximately 10 weeks; therefore although the newborn can see at birth, his or her visual acuity is usually between 20/100 and 20/400, making him or her hyperoptic (farsighted). Newborns cannot distinguish color and detail clearly. The infant sees best when objects are about 8 inches from his or her eyes. By age 2 or 3 the child’s visual acuity is 20/50, and by age 6 or 7 it is 20/20. It takes about 6 weeks for the lacrimal glands to mature, so although the newborn cries no tears are produced until he or she is approximately 1½ months old. The newborn’s sclera is thin, translucent, and bluish tinged, with a blue or gray iris. By 6 months of age the infant’s eye color matures and becomes permanent.
During the birth process a corneal tear or subconjunctival hemorrhage may occur. Newborn eye assessment includes observing for persistent and irregular uncoordinated eye movements and leukokoria (white pupil). If warranted, an ophthalmologist assesses the infant for iris abnormalities, including Brushfield spots associated with trisomy 21, colobomas (gap in the optic nerve or other eye structure), red reflex abnormalities, and chorioretinitis (congenital viral infection) (Table 29-1).
ECCHYMOSIS
A child may sustain orbital and soft tissue ecchymosis of the eyelid (black eye) related to a sport or playground injury, to a physical altercation with another child, or to child abuse. Because it is possible that an orbital fracture has occurred, eye injuries must be assessed, including eye movement and intraocular pressure (IOP). Cold compresses or ice packs applied for 5-10 minutes at a time may help reduce hemorrhage and edema.
Safety goggles should be worn by the child when playing sports (e.g., hockey, baseball, tennis, and racquetball) or when conducting experiments in chemistry or industrial arts classes to prevent eye injuries. Avoidance of extreme sports, such as bungee jumping, and prohibiting children from playing with fireworks or participating in paint ball games may also help prevent eye injuries.
BURNS
Eyelid burns may occur because of contact with a curling iron or a lighted cigarette. The conjunctiva and cornea may also be burned by thermal, chemical, or radiant energy. Ultraviolet keratitis may occur when skiing on a bright day without wearing goggles. Exposure to exploding batteries, drain cleaner, and bleach can cause chemical burns, which require immediate eye irrigation and emergency care. Alkaline agents cause a deeper burn than do acidic agents because alkaline substances penetrate deeper into tissue.
Ultraviolet keratitis may occur when skiing on a bright day without wearing goggles.
Table 29-1 Common Signs and Symptoms of Eye Disease
Signs
Meaning
Redness (injection)
Superficial or penetrating foreign bodies
Infection
Allergy
Conjunctivitis associated with Stevens-Johnson syndrome or Kawasaki’s disease
ECCHYMOSIS
BURNS
Ultraviolet keratitis may occur when skiing on a bright day without wearing goggles.
