Pediatric emergency medicine trisk 4052 4052
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can be used as often as hourly. Depending on the virus, symptoms may last for up
to 2 to 3 weeks. Patients with symptoms that appear to be getting worse or
persisting for longer than 1 week may benefit from ophthalmology consultation.
If a herpetic ocular infection is suspected, urgent ophthalmologic consultation is
required. Skin lesions not involving the eye lid margins or without any
conjunctival injection do not require ophthalmology consultation.
Allergic conjunctivitis is soothed by topical lubricants and cool compresses.
The combination vasoconstrictor/antihistamine preparations listed in Table 123.2
may also be prescribed. Patients with recurrent allergic conjunctivitis, atopy, or
asthma may benefit from long-term or seasonal topical mast cell stabilizers. A
host of antiallergy eye drops are now available, the review of which is beyond the
scope of this chapter. Topical glucocorticoids should not be prescribed by the ED
clinician without consultation with an ophthalmologist. Inappropriate use of
steroids may lead to glaucoma, cataracts, and can promote herpes virus
replication and corneal scarring. Finally, any patient who wears contact lenses
and has conjunctivitis, should remove their contact lenses immediately and be
referred for ophthalmology consultation. No topical drugs should be prescribed in
these cases without the supervision and consultation of an ophthalmologist.
Ocular Chemical Injury
CLINICAL PEARLS AND PITFALLS
Alkali ocular burns are more common and typically more severe than
acid burns.
Ocular irrigation involves continuous irrigation with saline or water (for
at least 20 minutes) until a neutral pH is achieved in the eye.
Ocular irrigation should never be delayed for sedation, examination, or
consultation purposes.
Current Evidence
Pediatric ocular chemical exposures often occur in preschool-aged children due to
accidental contact with household products such as organic solvents and other
cleaning agents. Chemical burns to the eye can cause extensive damage to the
ocular surface epithelium and cornea leading to blindness. The severity of
damage depends on the agent involved, the duration of contact, and the depth of
penetration. Acidic substances can cause significant damage on impact but
ultimately produce a “coagulum” that can create a barrier to further ocular
