Eye Injuries in Children

Eye Injuries in Children

 What is the prevalence of eye traumas?

The eye is one of the most commonly injured organs among all body injuries in general at a rate of 10%. 1% of all humans experience at least one eye injury in their lifetime.

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Figure 1: Eye injuries that occur during games

 

What is the prevalence of eye injuries in children? 

According to various statistics, about one third of all eye injuries are observed in children. Children are more prone to eye injuries than adults.

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Figure 2: Many ball games cause frequent eye injuries.

Why are eye injuries more common in children? 

Children are usually unable to evaluate the harm they can cause to themselves or their surroundings. Furthermore, their motor skills are not fully developed which leads to more frequent eye injuries.

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Figure 3: The eye of a child after a traumatic ball injury

What are the types of eye injuries?

A closed globe injury is when the eye wall is intact but the intraocular tissues are harmed depending on the severity of the impact. An open globe injury happens when the ocular integrity is disrupted by a sharp object and a rupture occurs.

What kind of damages may happen in closed globe injuries?

The intraocular space is like a balloon filled with liquid. Big objects that firmly hit the eye may cause serious damages without rupturing the eye. In closed globe injuries, contractions in the anterior-posterior axis and enlargement in the equator may happen. Then, the eye reverts back to its normal shape. These sudden changes in shape may cause serious direct or indirect damages in the eye. As a result of closed globe injuries, retinal edema, subretinal tears, intraocular hemorrhage, retinal tears and retinal detachment may occur.

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Figure 4: Eye damage caused by an object that firmly hits the eye 

How does retinal edema happen?

Retinal edema happens in both the area of impact and also the back of the eye. The affected portion of the retina will appear white due to the accumulation of fluid between the tissues. At the beginning, the vision is significantly affected because of the edema at the back of the eye. Depending on the severity of the edema, everything may go back to normal in a few days, or in more severe cases, permanent loss of vision may happen. Edema at the back of the eye may cause a late-term rupture which is called a macular hole and causes severe loss of vision.

How does intraocular hemorrhage happen?

Hemorrhage due to a closed globe trauma at the rich vascular structure of the eye fills the vitreous cavity. The coagulation it creates there takes sometimes months to clear. A hemorrhage that fails to clear for a long time is followed up by ultrasonography. If a retinal tear appears on an ultrasound, then an emergency vitrectomy is performed.

Do Closed Globe Traumas Cause Retinal Tears?

About 80% of all retinal detachments happen due to blunt trauma. Two kinds of retinal tears form as a result of an impact on the eye:

1-) The retinal damage at the site of impact first creates a sudden retinal edema. In some cases, after the formation of retinal edema, the retinal tissue dies and a quite large tear appears. Such tears are usually observed at the lower and outer side of the eye where the eye most frequently gets an impact.

2-) Another type of retinal tear formation is indirect retinal tear. The trauma causes the flexible eye globe to change its shape resulting in varying types and sizes of retinal detachments such as dialysis or giant retinal tear.

Following the formation of the retinal tear, a retinal detachment may occur by the introduction of vitreous fluid in the subretinal space. However, the majority of eye traumas happen to young people in whom the vitreous maintains its gel-like features, therefore at the beginning, there is usually no vitreous fluid that would pass behind the retinal tear. Thus, in young people, retinal detachment develops at a longer period of time than in advanced age. All traumatized cases should be given an early-stage detailed retinal examination by dilating the pupil in order to detect retinal tears and dialyses that precede the development of retinal detachment and to have the opportunity to perform preventive treatment such as laser or cryopexy (freezing treatment). If retinal detachment has already formed, depending on the condition of the tear, scleral buckling surgery or vitrectomy is performed. In scleral buckling, an external buckle of solid silicone is applied on the tear. In severe detachments, 3-port pars plana vitrectomy is performed. In some severe cases, multiple operations may be required for saving the eye.

 

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 Figure 5: Retinal tear and detachment at the lower hemisphere of the eye due to a ball injury 

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Figure 6: Giant retinal tear due to blunt trauma, the detached retina falling over the healthy retina

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Figure 7: Former Retinal Detachment due to Trauma

 

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Figure 8: Retinal Appearance after Traumatic Detachment Surgery

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Figure 9: Silicon oil shining in the eye of a patient who has received a post-traumatic vitrectomy

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Figure 10: 3 Port Vitrectomy (schematical)

Can Childhood Eye Injuries Be Prevented?

It is possible to prevent childhood or adult eye injuries at a rate of 47% to 65% by raising awareness and providing appropriate information and protection (USAIR). Using polycarbonate lenses in high-risk sports and activities prevents many eye injuries.

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