Paediatric Acute care Guidelines PMH Emergency Department

General

  • Perform a full examination on all patients presenting with eye problems and document findings in the patients medical records
  • Discuss all abnormalities with ED Senior Doctor or the on-call Ophthalmologist

Positioning and technique

Visual Acuity:

  • Must be documented in all children presenting with eye problems
  • Use age appropriate testing method
  • Think significant pathology if:
    • Sudden visual loss or reduced visual acuity
    • Penetrating eye injuries
    • Chemical burns – do not delay irrigation by performing visual acuity testing

Pupil Examination:

  • Record size and direct and consensual response to light
  • Swinging flashlight test – optic nerve injury

Eye Movement:

  • Check full range of movement and ask about diplopia
  • Look for nystagmus

Visual Fields:

  • Detailed examination in patients with reduced visual acuity

Direct assessment:

  • Look for foreign body, inflammation, oedema or discharge
  • Evert upper eyelid to exclude subtarsal foreign body

Fundoscopy:

  • Perform in a dark room
  • Check red reflex – absence is an abnormal finding (intraocular haemorrhage, cataracts, severe corneal abrasions or scarring)
  • Look for retinal haemorrhages

Slit Lamp Examination:

  • Allows detailed examination of conjunctiva, cornea and anterior chamber
  • Cannot be used in children under 3 years of age
  • Refer to guide attached to lamp for instruction of use

Fluorescein:

  • Shows corneal abnormalities when viewed under blue light
  • Consider herpetic dendrites if an ulcer is present without any history of trauma

Surrounding anatomy:

  • Eyelid laceration
    • Exclude lacrimal duct trauma
  • Orbit injuries
    • Bruising – exclude globe injury, facial fractures and basal skull fractures
    • Orbit fractures – characterised by restriction of extra ocular movement
  • Periorbital Cellulitis – consider orbital cellulitis if:
    • Reduced visual acuity
    • Proptosis
    • Ophthalmoplegia
    • Red eye

 

References

PMH ED Guideline Eye Examination: Last Updated October 2014

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