Eye Injuries in Children: Concerns and Treatment Options

Q: Eye Injuries in Children: Concerns and Treatment Options

Hello, Miss： Based on experience, your child's eye scratch is likely a superficial injury, so it should heal without leaving any scars. <br>If the injured area is located along the visual axis, it could significantly affect visual acuity. <br>For the reduction in vision, it is im

Child's eye injury concerns ~ urgent question?

Dear Dr.
Liu,
My daughter (almost five years old) was injured last Friday when a classmate accidentally scratched her eyeball with a textbook (an abrasion was noted during the evening examination).
She has been using eye drops and ointment for several days.
Today (Monday), during a follow-up visit for a vision test (as there were concerns about potential vision impairment), it was found that her injured eye has a vision of only 0.6 (left eye), while the right eye was 1.0 and the left eye was previously 0.9.
I inquired with the doctor whether the vision decline was due to the injury, but the doctor did not provide a clear answer, only stating, "It should be pseudomyopia, but it could also be related to the injury." I am quite worried, concerned whether it is simply pseudomyopia or if it is indeed due to the injury.
Currently, the doctor advised against continuing the previous eye drops and ointment, and instead prescribed PICON EYE DROPS 5M, with a follow-up in two weeks to check if her vision improves.
I am very anxious and would like to clarify whether the vision decline is caused by the injury (and if so, how to address it).
If it is purely pseudomyopia, is it sufficient to use the prescribed mydriatic drops? I have read that the doctor has mentioned using mydriatic agents that have a "ciliary muscle relaxant" effect in other articles.
Does the medication prescribed for my daughter have this effect? Are there other causes or methods to consider?
Additionally, can she take nutritional supplements (such as cod liver oil or mulberry)? What would be the appropriate dosage?
Thank you very much for your assistance!

kiki Chen, 20~29 year old female. Ask Date: 2006/03/27

Dr. Liu Jingxian reply Ophthalmology

Hello, Miss: Based on experience, your child's eye scratch is likely a superficial injury, so it should heal without leaving any scars.
If the injured area is located along the visual axis, it could significantly affect visual acuity.
For the reduction in vision, it is important to confirm whether a best-corrected visual acuity test (with glasses) was performed or if only uncorrected visual acuity was measured, as the implications of both are different.

"Pseudo-myopia" is myopia caused by the eye's accommodation, also known as "accommodative myopia." Children have stronger accommodative abilities than adults, making them more prone to pseudo-myopia.
At this stage, if the eyes can be given appropriate rest or treated with "cycloplegic agents" to relieve ciliary muscle tension, this type of "pseudo-myopia" can often return to normal.
However, if the ciliary muscle remains tense over time, it can lead to structural changes in the lens, resulting in "true" myopia.
Furthermore, if after a period of treatment with "long-acting cycloplegic agents," a refraction still shows myopia, this indicates it is not "pseudo-myopia," but rather "true" myopia.
Generally, we use short-acting cycloplegic agents (such as Tropicamide), which are administered once before bedtime and have an effect lasting about six hours, allowing for normal activities upon waking.
Some may use long-acting cycloplegic agents (such as Atropine: 0.1%, 0.25%, 0.5%, 1.0%), which can last up to two weeks and provide a more effective relaxation of the ciliary muscle compared to short-acting agents.
The PICON EYE DROPS 5M you are using is a short-acting cycloplegic agent (tropicamide).
Therefore, it is still recommended that you discuss your child's condition in detail with their ophthalmologist for clarity.
As for the supplements mentioned, they should be considered from a health food perspective, with a balanced diet being the primary condition.
The necessary nutrients may vary based on different situations, so I do not recommend specific supplements here.
In summary, it is essential to pay attention to eye care, avoid excessive eye strain, and not over-fatigue the eyes, as this is the way to protect vision.
If you have any related questions, feel free to consult the ophthalmology department at the City United Hospital.
Wishing you good health.

Taiwan e-Academy Ophthalmology
Taipei City United Hospital, Zhongxing Branch
Dr.
Liu Jing-Hsiu

Reply Date: 2006/03/27

More Info

Understanding eye injuries in children is crucial, especially when it comes to potential long-term effects on vision. In the case of your daughter, who sustained an eye injury from a classmate's textbook, it is understandable to have concerns about her vision, particularly given the drop in visual acuity from 0.9 to 0.6 in her left eye.

Firstly, it is important to differentiate between "pseudomyopia" (or "false myopia") and actual vision loss due to injury. Pseudomyopia is a condition where the eye's focusing mechanism causes temporary nearsightedness, often due to prolonged near work or eye strain. Children are particularly susceptible to this because their accommodative (focusing) ability is stronger than that of adults. If your daughter's vision was previously normal and has now decreased, it could be a result of either the injury or pseudomyopia.

The fact that the injury site appears to have healed without visible scarring is a positive sign. However, the decrease in vision could still be related to the injury, especially if the injury affected the visual axis or caused any internal damage that isn't immediately visible. It is essential to ensure that her vision is being assessed correctly. The difference between "best corrected vision" (with glasses) and "uncorrected vision" (without glasses) can provide more insight into whether her vision issues are due to the injury or a refractive error.

The use of PICON EYE DROPS, which is a short-acting cycloplegic agent (similar to tropicamide), is intended to relax the ciliary muscle of the eye, thereby alleviating the strain that could contribute to pseudomyopia. This treatment can help in cases where the eye is over-accommodating, but it is crucial to monitor her vision closely during this period. If her vision does not improve after the treatment, further evaluation may be necessary to rule out any underlying issues related to the injury.

Regarding nutritional supplements, while a balanced diet is essential for overall eye health, specific supplements like fish oil or bilberry (山桑子) should be approached cautiously. There is limited scientific evidence supporting the effectiveness of these supplements in treating vision problems. It is best to consult with a pediatrician or a nutritionist to determine if any specific dietary changes or supplements are appropriate for your daughter.

In summary, it is vital to maintain open communication with your daughter's eye care provider. If her vision does not improve or if you notice any other concerning symptoms, such as pain, redness, or persistent blurry vision, do not hesitate to seek further evaluation. Regular follow-ups will help ensure that any potential issues are addressed promptly. Additionally, encouraging your daughter to take breaks during near work and to engage in outdoor activities can help reduce eye strain and promote better eye health.

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