Expert consensus of the treatment of pediatric ocular trauma in China (2024)_Chinese Journal of Ocular Fundus Diseases

Authors：

 Ophthalmology Group, Ophthalmology Society, Chinese Medical Association

Corresponding author：

Ophthalmology Group, Ophthalmology Society, Chinese Medical Association, Email: zyyyanhua@tmu.edu.cn

Keywords：

Endophthalmitis; Infectivity; Children; Ocular trauma; Prophylaxis and management; Expert consensus

DOI：

10.3760/cma.j.cn511434-20241225-00507

Video：

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Ocular trauma is the most common cause of monocular vision loss in children. Among the patients with eye trauma in China, 15%-20% are children. The complexity of diagnosis and treatment and the uncertainty of prognosis are high because the ocular tissue of children is not fully developed and the history collection and examination are difficult. In order to further standardize the treatment of children's eye trauma and improve the treatment level, Ophthalmology Group, Ophthalmology Society, Chinese Medical Association has formulated Expert consensus of the treatment of pediatric ocular trauma in China by combining domestic and foreign literature and the actual medical situation in China. This consensus provides detailed recommendations on the classification, cause of injury, history collection, examination methods, diagnosis and treatment principles of pediatric eye trauma. This consensus applies to Chinese ophthalmologists and medical personnel engaged in the treatment of children's eye trauma, aiming to provide scientific guidance for the diagnosis and treatment of children's eye trauma, assist clinical decision-making, and further improve the treatment level of children's eye trauma in China.

1.	王甜, 颜华. 儿童眼外伤特点及治疗进展[J]. 中华眼外伤职业眼病杂志, 2016, 38(11): 877-880. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.022.Wang T, Yan H. The characteristics and treatment progress in pediatric ocular trauma[J]. Chin J Ocul Traum Occupat Eye Dis, 2016, 38(11): 877-880. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.022.
2.	Boret C, Brehin C, Cortey C, et al. Pediatric ocular trauma: characteristics and outcomes among a French cohort (2007-2016)[J]. Arch Pediatr, 2020, 27(3): 128-134. DOI: 10.1016/j.arcped.2020.01.002.
3.	Abbott J, Shah P. The epidemiology and etiology of pediatric ocular trauma[J]. Surv Ophthalmol, 2013, 58(5): 476-485. DOI: 10.1016/j.survophthal.2012.10.007.
4.	Rodríguez-Ares MT, Touriño R, Lamas-Francis D, et al. Hand sanitiser-associated ocular chemical injury in children[J]. J Paediatr Child Health, 2021, 57(12): 2008-2009. DOI: 10.1111/jpc.15395.
5.	Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American society of anesthesiologists practice guidelines for preoperative fasting: carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration-a modular update of the 2017 American society of anesthesiologists practice guidelines for preoperative fasting[J]. Anesthesiology, 2023, 138(2): 132-151. DOI: 10.1097/ALN.0000000000004381.
6.	王传林, 刘斯, 邵祝军, 等. 外伤后破伤风疫苗和被动免疫制剂使用指南[J]. 中国疫苗和免疫, 2020, 26(1): 111-115,127.Wang CL, Liu S, Shao ZJ, et al. Guidelines for post-traumatic use of tetanus vaccines and passive immune preparations[J]. Chinese Journal of Vaccines and Immunization, 2020, 26(1): 111-115,127.
7.	Soleimani M, Cheraqpour K, Salari F, et al. All about traumatic cataracts: narrative review[J]. J Cataract Refract Surg, 2024, 50(7): 760-766. DOI: 10.1097/j.jcrs.0000000000001424.
8.	中华医学会眼科学分会白内障及屈光手术学组. 中国儿童白内障围手术期管理专家共识(2022年)[J]. 中华眼科杂志, 2022, 58(5): 326-333. DOI: 10.3760/cma.j.cn112142-20211115-00540.Cataract and refractive Surgery Group, Society of Ophthalmology, Chinese Medical Association. Chinese expert consensus on the perioperative management of cataracts in children (2022)[J]. Chin J Ophthalmol, 2022, 58(5): 326-333. DOI: 10.3760/cma.j.cn112142-20211115-00540.
9.	Lee CH, Lee L, Kao LY, et al. Prognostic indicators of open globe injuries in children[J]. Am J Emerg Med, 2009, 27(5): 530-535. DOI: 10.1016/j.ajem.2008.04.004.
10.	Liu X, Wang L, Yang F, et al. Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy[J]. Eur J Ophthalmol, 2022, 32(1): 546-552. DOI: 10.1177/11206721211000648.
11.	Sindal MD, Gondhale HP, Srivastav K. Clinical profile and outcomes of rhegmatogenous retinal detachment related to trauma in pediatric population[J]. Can J Ophthalmol, 2021, 56(4): 231-236. DOI: 10.1016/j.jcjo.2020.12.001.
12.	Lemley CA, Han DP. An age-based method for planning sclerotomy placement during pediatric vitrectomy: a 12-year experience[J]. Trans Am Ophthalmol Soc, 2007, 105: 86-91.
13.	Wu H, Ding X, Zhang M, et al. Pediatric posttraumatic endophthalmitis[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(10): 1919-1922. DOI: 10.1007/s00417-016-3330-1.
14.	Bansal P, Venkatesh P, Sharma Y. Posttraumatic endophthalmitis in children: epidemiology, diagnosis, management, and prognosis[J]. Semin Ophthalmol, 2016, 33(2): 284-292. DOI: 10.1080/08820538.2016.1238095.
15.	Yan H, Yang K, Ma Z, et al. Guideline for the treatment of no light perception eyes induced by mechanical ocular trauma[J]. J Evid Based Med, 2022, 15(3): 302-314. DOI: 10.1111/jebm.12496.
16.	Salvin JH. Systematic approach to pediatric ocular trauma[J]. Curr Opin Ophthalmol, 2007, 18(5): 366-372. DOI: 10.1097/ICU.0b013e3282ba54ac.
17.	Güçlü ES, Özer Ö. Pediatric canalicular lacerations: epidemiology and surgical outcomes[J/OL]. J Craniofac Surg, 2024, 35(7): e624-e627[2024-05-06]. https://pubmed.ncbi.nlm.nih.gov/38709087/. DOI: 10.1097/SCS.0000000000010230.
18.	中华医学会眼科学分会眼整形眼眶病学组. 眼眶爆裂性骨折诊疗专家共识(2014年)[J]. 中华眼科杂志, 2014, 50(8): 624-625. DOI: 10.3760/cma.j.issn.0412-4081.2014.08.019.Group of Orthopaedics and Orbits, Society of Ophthalmology, Chinese Medical Association. Expert consensus on the diagnosis and treatment of orbital blowout fracture (2014)[J]. Chin J Ophthalmol, 2014, 50(8): 624-625. DOI: 10.3760/cma.j.issn.0412-4081.2014.08.019.
19.	Pandya RP, Deng W, Hodgson NM. Current guidelines and opinions in the management of orbital floor fractures[J]. Otolaryngol Clin North Am, 2023, 56(6): 1101-1112. DOI: 10.1016/j.otc.2023.05.002.
20.	Kwon JH, Moon JH, Kwon MS, et al. The differences of blowout fracture of the inferior orbital wall between children and adults[J]. Arch Otolaryngol Head Neck Surg, 2005, 131(8): 723-727. DOI: 10.1001/archotol.131.8.723.
21.	Karimi S, Arabi A, Ansari I, et al. A systematic literature review on traumatic optic neuropathy[J/OL]. J Ophthalmol, 2021, 2021: 5553885[2021-02-06]. https://pubmed.ncbi.nlm.nih.gov/33728056/. DOI: 10.1155/2021/5553885.
22.	Chen HH, Lee MC, Tsai CH, et al. Surgical decompression or corticosteroid treatment of indirect traumatic optic neuropathy: a randomized controlled trial[J]. Ann Plast Surg, 2020, 84(1S Suppl 1): S80-83. DOI: 10.1097/SAP.0000000000002186.
23.	中华医学会眼科学分会神经眼科学组. 我国外伤性视神经病变内镜下经鼻视神经管减压术专家共识(2016年)[J]. 中华眼科杂志, 2016, 52(12): 889-893. DOI: 10.3760/cma.j.issn.0412-4081.2016.12.004.Neuro-ophthalmology Group, Society of Ophthalmology, Chinese Medical Association. Expert consensus on endoscopic transnasal optic canal decompression for traumatic optic neuropathy in China (2016)[J]. Chin J Ophthalmol, 2016, 52(12): 889-893. DOI: 10.3760/cma.j.issn.0412-4081.2016.12.004.

1. 王甜, 颜华. 儿童眼外伤特点及治疗进展[J]. 中华眼外伤职业眼病杂志, 2016, 38(11): 877-880. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.022.Wang T, Yan H. The characteristics and treatment progress in pediatric ocular trauma[J]. Chin J Ocul Traum Occupat Eye Dis, 2016, 38(11): 877-880. DOI: 10.3760/cma.j.issn.2095-1477.2016.11.022.
2. Boret C, Brehin C, Cortey C, et al. Pediatric ocular trauma: characteristics and outcomes among a French cohort (2007-2016)[J]. Arch Pediatr, 2020, 27(3): 128-134. DOI: 10.1016/j.arcped.2020.01.002.
3. Abbott J, Shah P. The epidemiology and etiology of pediatric ocular trauma[J]. Surv Ophthalmol, 2013, 58(5): 476-485. DOI: 10.1016/j.survophthal.2012.10.007.
4. Rodríguez-Ares MT, Touriño R, Lamas-Francis D, et al. Hand sanitiser-associated ocular chemical injury in children[J]. J Paediatr Child Health, 2021, 57(12): 2008-2009. DOI: 10.1111/jpc.15395.
5. Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American society of anesthesiologists practice guidelines for preoperative fasting: carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration-a modular update of the 2017 American society of anesthesiologists practice guidelines for preoperative fasting[J]. Anesthesiology, 2023, 138(2): 132-151. DOI: 10.1097/ALN.0000000000004381.
6. 王传林, 刘斯, 邵祝军, 等. 外伤后破伤风疫苗和被动免疫制剂使用指南[J]. 中国疫苗和免疫, 2020, 26(1): 111-115,127.Wang CL, Liu S, Shao ZJ, et al. Guidelines for post-traumatic use of tetanus vaccines and passive immune preparations[J]. Chinese Journal of Vaccines and Immunization, 2020, 26(1): 111-115,127.
7. Soleimani M, Cheraqpour K, Salari F, et al. All about traumatic cataracts: narrative review[J]. J Cataract Refract Surg, 2024, 50(7): 760-766. DOI: 10.1097/j.jcrs.0000000000001424.
8. 中华医学会眼科学分会白内障及屈光手术学组. 中国儿童白内障围手术期管理专家共识(2022年)[J]. 中华眼科杂志, 2022, 58(5): 326-333. DOI: 10.3760/cma.j.cn112142-20211115-00540.Cataract and refractive Surgery Group, Society of Ophthalmology, Chinese Medical Association. Chinese expert consensus on the perioperative management of cataracts in children (2022)[J]. Chin J Ophthalmol, 2022, 58(5): 326-333. DOI: 10.3760/cma.j.cn112142-20211115-00540.
9. Lee CH, Lee L, Kao LY, et al. Prognostic indicators of open globe injuries in children[J]. Am J Emerg Med, 2009, 27(5): 530-535. DOI: 10.1016/j.ajem.2008.04.004.
10. Liu X, Wang L, Yang F, et al. Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy[J]. Eur J Ophthalmol, 2022, 32(1): 546-552. DOI: 10.1177/11206721211000648.
11. Sindal MD, Gondhale HP, Srivastav K. Clinical profile and outcomes of rhegmatogenous retinal detachment related to trauma in pediatric population[J]. Can J Ophthalmol, 2021, 56(4): 231-236. DOI: 10.1016/j.jcjo.2020.12.001.
12. Lemley CA, Han DP. An age-based method for planning sclerotomy placement during pediatric vitrectomy: a 12-year experience[J]. Trans Am Ophthalmol Soc, 2007, 105: 86-91.
13. Wu H, Ding X, Zhang M, et al. Pediatric posttraumatic endophthalmitis[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(10): 1919-1922. DOI: 10.1007/s00417-016-3330-1.
14. Bansal P, Venkatesh P, Sharma Y. Posttraumatic endophthalmitis in children: epidemiology, diagnosis, management, and prognosis[J]. Semin Ophthalmol, 2016, 33(2): 284-292. DOI: 10.1080/08820538.2016.1238095.
15. Yan H, Yang K, Ma Z, et al. Guideline for the treatment of no light perception eyes induced by mechanical ocular trauma[J]. J Evid Based Med, 2022, 15(3): 302-314. DOI: 10.1111/jebm.12496.
16. Salvin JH. Systematic approach to pediatric ocular trauma[J]. Curr Opin Ophthalmol, 2007, 18(5): 366-372. DOI: 10.1097/ICU.0b013e3282ba54ac.
17. Güçlü ES, Özer Ö. Pediatric canalicular lacerations: epidemiology and surgical outcomes[J/OL]. J Craniofac Surg, 2024, 35(7): e624-e627[2024-05-06]. https://pubmed.ncbi.nlm.nih.gov/38709087/. DOI: 10.1097/SCS.0000000000010230.
18. 中华医学会眼科学分会眼整形眼眶病学组. 眼眶爆裂性骨折诊疗专家共识(2014年)[J]. 中华眼科杂志, 2014, 50(8): 624-625. DOI: 10.3760/cma.j.issn.0412-4081.2014.08.019.Group of Orthopaedics and Orbits, Society of Ophthalmology, Chinese Medical Association. Expert consensus on the diagnosis and treatment of orbital blowout fracture (2014)[J]. Chin J Ophthalmol, 2014, 50(8): 624-625. DOI: 10.3760/cma.j.issn.0412-4081.2014.08.019.
19. Pandya RP, Deng W, Hodgson NM. Current guidelines and opinions in the management of orbital floor fractures[J]. Otolaryngol Clin North Am, 2023, 56(6): 1101-1112. DOI: 10.1016/j.otc.2023.05.002.
20. Kwon JH, Moon JH, Kwon MS, et al. The differences of blowout fracture of the inferior orbital wall between children and adults[J]. Arch Otolaryngol Head Neck Surg, 2005, 131(8): 723-727. DOI: 10.1001/archotol.131.8.723.
21. Karimi S, Arabi A, Ansari I, et al. A systematic literature review on traumatic optic neuropathy[J/OL]. J Ophthalmol, 2021, 2021: 5553885[2021-02-06]. https://pubmed.ncbi.nlm.nih.gov/33728056/. DOI: 10.1155/2021/5553885.
22. Chen HH, Lee MC, Tsai CH, et al. Surgical decompression or corticosteroid treatment of indirect traumatic optic neuropathy: a randomized controlled trial[J]. Ann Plast Surg, 2020, 84(1S Suppl 1): S80-83. DOI: 10.1097/SAP.0000000000002186.
23. 中华医学会眼科学分会神经眼科学组. 我国外伤性视神经病变内镜下经鼻视神经管减压术专家共识(2016年)[J]. 中华眼科杂志, 2016, 52(12): 889-893. DOI: 10.3760/cma.j.issn.0412-4081.2016.12.004.Neuro-ophthalmology Group, Society of Ophthalmology, Chinese Medical Association. Expert consensus on endoscopic transnasal optic canal decompression for traumatic optic neuropathy in China (2016)[J]. Chin J Ophthalmol, 2016, 52(12): 889-893. DOI: 10.3760/cma.j.issn.0412-4081.2016.12.004.

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