Pediatric emergency medicine trisk 4055 4055
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FIGURE 123.12 Irrigation setup for ocular lavage (A ) and the Morgan Lens (B ).
Ophthalmology consultation is indicated in cases of significant chemical injury.
Waiting for the consultant should not delay irrigation and the ophthalmologist
should be notified while lavage is ongoing. In cases of very minor exposure to
substances that are clearly neither alkaline nor strongly acidic, and when the eye
is not injected, an ophthalmology consultation may be deferred. However, the ED
clinician should be cautious about the absence of conjunctival injection because
alkali burns can cause blanching of the conjunctiva, which is a poor prognostic
sign.
Hordeolums and Chalazions
A hordeolum is an acute infection of the eyelid that presents as a localized painful
swelling. Hordeola can be external (resulting from blockage of a gland of Zeis on
the lid margin; classic “stye”) or internal (resulting from blockage of a
meibomian gland). A chalazion, which also results from a blocked eyelid gland,
may initially present with some inflammation and tenderness, but typically
progresses to a painless localized eyelid swelling as the inflammation resolves.
Styes and chalazions are typically sterile but can progress to infection, most
commonly with staphylococcal species.
