Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral

Table 1

Ophthalmological examination.

	Findings requiring urgent ophthalmological review	How to assess in the paediatric patient
Visual acuity	Reduced/loss of vision	(i) Paediatric Snellen chart; (ii) Counting examiner’s displayed fingers; (iii) Detecting hand motion; (iv) Ask patient if they can see
Pupillary light response: direct and consensual	Sluggish/loss of direct reflex; Sluggish/loss of consensual reflex	As in adults
Swinging light test	Presence of rapid afferent pupillary defect/Marcus Gunn pupil in affected eye	As in adults
Pupil size	Dilatation	As in adults
Pain	Pain	(i) Direct questioning
Fields	Restriction; Diplopia; Pain on movement	(i) Use an object of interest; (ii) Ask patient about double vision and pain
Colour	Desaturation/loss of red reflex	Not possible in the very young; (i) Direct questioning; (ii) Matching of coloured objects
Position of globe	Proptosis; Enophthalmos	As in adults