From the Guidelines
A contusion to a toddler's eyelid can cause several serious complications, including vision loss, orbital fractures, and infection, which require immediate medical attention. According to the most recent study 1, traumatic injury is the leading cause of noncongenital monocular vision loss in children, and common signs of orbital injuries include periorbital soft tissue swelling, ecchymosis, hyphemia, subconjunctival hemorrhage, diplopia, restriction of ocular movement, or vision loss. The study also notes that orbital fractures account for 3% to 45% of all pediatric facial fractures, and serious ocular injuries in conjunction with orbital fracture are less common in children compared with adults.
Some potential complications of a contusion to a toddler's eyelid include:
- Infection, which can present as increased redness, warmth, or discharge, and may require antibiotic treatment 1
- Vision problems, which can occur if the trauma affects the eye itself, not just the lid 1
- Damage to the tear ducts, which can cause excessive tearing or dry eye 1
- Orbital compartment syndrome, which can develop in rare cases and requires emergency treatment 1
- Ptosis (drooping of the eyelid), which may occur due to damage to the levator muscle 1
For treatment, apply cold compresses for 15-20 minutes several times daily during the first 24-48 hours to reduce swelling, and seek immediate medical attention if your child shows signs of vision changes, severe pain, protruding eyeball, or if the eyelid appears infected. Acetaminophen (Tylenol) can be given for pain at age-appropriate doses. It is essential to monitor the child's condition closely and seek medical attention immediately if any concerning symptoms develop, as the delicate tissues around the eye have limited space to accommodate swelling, and the proximity to the eye itself makes any trauma in this area potentially serious 1.
From the Research
Complications of Contusion to Toddler Eyelid
- A contusion to the toddler eyelid can cause various complications, including:
- Subconjunctival hemorrhage, which is a common injury associated with orbital fractures 2
- Vision-threatening posterior segment findings, such as retinal tear and choroidal rupture, although these are relatively rare 2
- Ocular trauma can lead to serious sight- and eye-threatening consequences, including chemical eye injuries, orbital fractures, and closed globe injury 3
- Blurry vision, ocular pain, facial pain, poor vision, and afferent pupillary defect can increase the odds of severe injury 4
- The management of eyelid and periorbital soft tissue trauma requires restoration of normal anatomic relationships of the eyelids and periocular structures for optimum functional and aesthetic outcome after trauma 5
- Vision loss following orbital and facial trauma can occur due to traumatic optic neuropathy, retrobulbar haemorrhage, and penetrating eye injury, and management options include surgical decompression, systemic steroid therapy, and conservative management 6
Risk Factors for Ocular Injury
- Severe ocular injury is associated with poor vision, afferent pupillary defect, and abnormal pupillary reaction 4
- Blurry vision, ocular pain, and facial pain can increase the risk of severe ocular injury 4
- Demographic factors, mechanism of injury, anti-coagulant use, fracture location, diplopia, and subconjunctival hemorrhage are not associated with injury severity 4
Management of Ocular Trauma
- A structured approach to history and examination is crucial in assessing patients with ocular trauma 3
- Accurate history-taking and astute observation are paramount for timely treatment or referral that may prevent blindness 3
- Management options for traumatic vision-threatening injury include surgical decompression, systemic steroid therapy, and conservative management 6