Pediatric Retinal Trauma

18.1  Introduction

Trauma to the posterior segment of the globe in children encompasses a wide variety of presentations and clinical manifestations. It often results in significant ocular morbidity and remains the most frequent cause of unilateral blindness [1, 2]. The consequences of pediatric ocular trauma pose a serious challenge to the patient, family, and treating ophthalmologist. Several features of the child’s response to ocular trauma make treatment difficult. These include (1) the child’s high level of anxiety, which may necessitate anesthesia for an accurate examination; (2) a vigorous and exuberant healing response with a significant fibrotic component;

(3) different surgical anatomy and physical relationships that require specific understanding, and the battle with amblyopia that begins at the moment of the injury and compounded by media opacities, aphakia, undesired astigmatism, and retinal pathology.

In recent years, there have been advances in both the medical and surgical management of such injuries, including the advent of new vitreoretinal surgical instrumentation and principles. These advances in combination with careful evaluation and aggressive intervention have improved visual recovery in some cases. In this chapter, we discuss a spectrum of posterior segment injuries in children. We review the principles of epidemiology, diagnosis, and clinical management when appropriate.

To aid in the evaluation and management of trauma, a classification system has been proposed by Kuhn

M.A. Samuel and K.A. Tawansy (*)

Children’s Hospital of Los Angeles, 7447 N. Figueroa Street, Suite 200, Los Angeles, CA 90041, USA

e-mail: ktawansy@chla.usc.edu

et al. [3]. We find this classification to be unambiguous and critically important in organizing commonly used terms into a usable language. In its simplest form, ocular trauma can be divided into two categories: closed globe and open globe injuries. Closed globe injury denotes an absence of a full-thickness wound. Instead, a closed globe injury involves blunt trauma to the globe or adjacent structures with no resulting corneal or scleral wound, a form of contusion injury. A closed globe injury may also involve partial thickness lacerations of the eye wall. Open globe injuries result in a full-thickness wound, which can be further divided into subcategories based upon the type and extent of damage. A full-thickness wound of the eye wall caused by a blunt object is defined as a rupture. A similar injury caused by a sharp object is defined as a laceration. Lacerations can either penetrate the eye if there is a single eye wall laceration, or perforate the eye if entry and exit lacerations are present. Finally, corneal and scleral lacerations can also be associated with intraocular foreign bodies.

18.2  Epidemiology

Ocular trauma in children is relatively common and potentially preventable. It has been estimated that 90% of all ocular injuries can be avoided with proper eye protection and supervision [4]. It is important to understand the epidemiology of this public health problem in order to determine the most effective methods of reducing damage.

Several large series have been published describing the epidemiology of pediatric eye injuries [5–7]. However, large population-based studies are few. Estimates of the incidence of ocular trauma in children