Outcome and prognosis of pediatric patients with delayed diagnosis of open-globe injuries.
OBJECTIVE
Open-globe injuries in children can present in a delayed fashion, potentially increasing the risk of endophthalmitis and delaying surgical intervention. This article presents the outcome of pediatric patients with delayed diagnosis of open-globe injuries for 24 hours or more.


METHODS
The study was a retrospective observational case series of patients who presented with open-globe injuries diagnosed 24 hours or more after the injury between July 2002 and March 2007.


RESULTS
Thirteen patients were included in the study. The average age at presentation was 5.8 +/- 2.8 years; average follow-up was 11.5 +/- 14.5 months. Mean time of presentation after injury was 9.2 +/- 16.0 days. The most common chief complaints were chronic red eye (7 of 13 patients), eye pain (5 of 13 patients), and decreased vision (4 of 13 patients). All patients had self-sealing corneal wounds; 8 of 13 patients had a visually significant traumatic cataract. One patient had sympathetic ophthalmia. Initial visual acuity was 20/200 or worse in 10 patients, and final visual acuity was 20/40 or better in 6 patients. No patient had endophthalmitis.


CONCLUSIONS
Open-globe injuries, especially self-sealing corneal wounds, can present in a delayed fashion in children or may be missed if obvious findings, such as subconjunctival hemorrhage or prolapsed iris tissue, are not present. Pediatricians should be educated that they should maintain a high level of suspicion in the setting of chronic unilateral red eye, decreased visual acuity, or abnormal red reflex.
Acuna
Olga M
OM
Cullen Eye Institute, Baylor College of Medicine, Texas Children Hospital, Houston, Texas, USA.
Yen
Kimberly G
KG
D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D003941:Diagnostic Techniques, Ophthalmological; D015807:Eye Injuries, Penetrating / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices