RESUMO
PURPOSE: To describe the epidemiology of ocular emergencies in children in a hospital-based emergency room (ER). METHODS: The medical reports of all children, 14 years of age and younger, who attended La Paz University Hospital (Madrid, Spain) ER from September 2015 to August 2016 were prospectively collected. Demographic data, origin, symptom for consultation, diagnostic tests, final diagnosis, and final referral of patients were recorded. RESULTS: A total of 774 children were attended: 57% boys and 43% girls. Mean age was 5 years (SD 4.10 years, range 0-14 years) without significant differences between sexes. Most children went to the ER because parents or teachers took the decision (75%), 24% were referred from the paediatric ER for evaluation, and 0.78% were referred from another hospital or by an out-clinic ophthalmologist. The reasons for consultation were red eyes (61%), traumatism (17%), referred from the paediatrician to have the fundus explored in children with headache (7%), eyelids problems (7%), and visual loss (7%). The most frequent diagnoses were infectious conjunctivitis (29%), corneal erosion (17%), normal examination (15%), and allergic conjunctivitis (13%). The most severe cases (visual loss, acute strabismus, and leucocoria) were referred by the paediatricians and represented 4.65% of the total patients. Visits occurred more frequently during the third trimester of the year (July-September), with a higher incidence of eye trauma in summer. CONCLUSIONS: Infectious conjunctivitis was the most frequent pathology. It is necessary to increase public awareness about the symptoms, the way of transmission, and treatment. Ocular trauma was also a common cause of presentation and the majority were contusional and mild. There is also a need for education of parents, teachers, and coaches regarding the potential for eye injuries. Ophthalmologists and paediatricians must take an active role in educating people about the prophylactic measures to prevent eye injuries in children.
RESUMO
PURPOSE: To study the relationship between macular ganglion cell complex (GCC) thickness and visual field defects (VFD) caused by central nervous system (CNS) lesions in children and evaluate the possibility of predicting VFD according to GCC maps. METHODS: The GCC maps of a group of children with VFD due to CNS lesions with respect of the vertical meridian in at least one eye (study group), as well as of children with other neuro-ophthalmological problems and healthy children were presented to two masked evaluators, who were asked to predict the patients' VFD on the basis of GCC damage: the evaluators classified VFD as normal, hemianopia (homonymous or heteronymous) or diffuse. RESULTS: Seventeen patients were included in the study group, with a median age of 12 years. Fifteen had brain tumours and two epilepsy. The mean MD of the affected hemifields was -26.00 dB (SD 7.89 dB) versus -5.51 dB (SD 3.52 dB) for the nonaffected hemifields, p < 0.001. The mean GCC thickness was of 56.04 µm (SD 11.95 µm) in the affected hemiretinas versus 74.31 µm (SD 10.64 µm) for the non-affected, p < 0.001. Kappa coefficients between VFD and those estimated by the evaluators were 0.705 and 0.658 (p < 0.001) for evaluators 1 and 2. CONCLUSIONS: GCC thickness can reflect damage to the visual pathway and GCC maps may be useful to identify chiasmal and retrochiasmal lesions, since GCC atrophy in most of these cases respects the vertical meridian. GCC maps might be used as a surrogate marker for visual damage in patients unable to perform perimetry.