Treatment of Blunt Eye Trauma in Children

Initial Assessment and Management

Children with known or suspected eye trauma and significant vision impairment should be referred to a pediatric ophthalmologist who has completed specialized training in pediatric ophthalmology 1
The American Academy of Pediatrics recommends immediate referral to a pediatric ophthalmologist for children with blunt trauma to the eye, significant vision impairment, and periorbital swelling 1

A complete eye examination, including visual acuity testing, cycloplegic refraction, funduscopic examination, and sensorimotor evaluation, should be performed by a pediatric ophthalmologist 3, 4, 5
The American Academy of Ophthalmology recommends CT imaging to evaluate for orbital floor fracture, muscle or periorbital tissue entrapment, and other structural damage to the orbit 2

The risk of developing amblyopia, especially in children, if visual impairment persists, should be assessed by a pediatric ophthalmologist 6, 7
Entrapment of the inferior rectus muscle or orbital contents in case of orbital floor fracture can cause diplopia and restricted eye movement, and should be evaluated by a pediatric ophthalmologist 2

Cycloplegic agents may be prescribed by a pediatric ophthalmologist to reduce pain and prevent complications 4, 5
Surgical intervention may be required if there is evidence of entrapped muscle or periorbital tissue, "white-eyed blow-out fracture" with oculocardiac reflex, or large floor fractures or hypoglobus, as recommended by the American Academy of Ophthalmology 2

Close follow-up examinations should be arranged according to the severity of injury, typically within 2-3 months of initiating treatment, as recommended by the American Academy of Ophthalmology 7
Vision rehabilitation services, educational accommodations, and evaluation for an Individualized Education Program (IEP) may be necessary if vision impairment persists, as recommended by the American Academy of Ophthalmology 8
Protective eyewear should be prescribed if vision remains impaired, especially for sports and other activities, as recommended by the American Academy of Ophthalmology 6