![]() Look for pupillary light reflex (direct and consensual response for each eye), pupil shape and size, symmetry with other eye.Visual acuity (and visual fields if there is visual loss/change).Avoid repeated administration of anaesthetic eye drops due to direct epithelial toxicity that can delay corneal healingĮssential components of examination and the order in which they should be performed are:.One drop into the affected eye will induce anaesthesia after 20 seconds and the effect lasts 10 – 20 minutes (longer with 1%).Topical anaesthetic such as tetracaine (amethocaine) 0.5% or 1% can be used to assist with examination.Adequate analgesia will aid assessment and procedural sedation may be required in the younger child.A lot of information can be gathered by initially observing the child (eg eye red or white, cellulitis or swelling of eyelids, ptosis, proptosis, eye movements, cranial nerve palsy).It is usually not necessary to dilate a child’s pupils in emergency for assessment and should not be done in situations of head injury or trauma.Key features of sight threatening conditions are severe eye pain, photophobia, decreased visual acuity or a history of possible penetrating eye trauma.Topical anaesthetic eye drops, although initially painful, can be very useful as it will relieve pain for about 20 minutes and may allow the child to spontaneously open their eye after a couple of minutes Assessment of the eye and vision can be very difficult in children, particularly if the child is injured or distressed.Serious periocular trauma should be treated as a suspected ruptured or penetrated globe and managed by minimising distress, placing an eye shield and urgently referring to ophthalmology, see.Stain with fluorescein if corneal abrasion, ulcer or foreign body is suspected Fluorescein shows corneal abnormalities when viewed under cobalt blue light.Adequate analgesia will aid examination and procedural sedation may be required in the younger child.Visual acuity is assessed for each eye based on the child’s age and ability to interact.Assessing visual acuity can be difficult but should be performed early (before examination when the child may become distressed).Acute red eye Acute eye injury Penetrating eye injury Periorbital cellulitis Key points
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