HISTORY The emergency provider should quickly assess the child’s relevant past history in order to assess the expected baseline visual acuity The mechanism of injury should also be ascertained in order to understand the risk of serious ocular pathology and predict injury patterns Finally, the patient should be asked about current symptoms including pain, decrease in vision, foreign body sensation, photophobia, or tearing Assessment of Prior Eye Pathology and Relevant Medical History It is important to establish the child’s prior ocular history in order to assess the anticipated baseline visual acuity A history of poor vision including use of contact lenses or glasses, amblyopia, or strabismus surgery should be queried If the child is wearing contact lenses, they should be removed if this can be done safely A history of systemic disorders may predispose some children to specific injuries or worse outcomes For example, patients with collagen disorders are more prone to open-globe injuries or intraocular hemorrhage, and patients with sickle cell anemia have a higher incidence of complications from hyphema Assessment of Injury Mechanism Clinicians should assess the exact mechanism of injury as the type of trauma and the nature of the force inflicted may predict injury patterns and prognosis For example, significant blunt impact directly to the globe (e.g., baseballs), projectiles, and sharp objects (e.g., sticks or pencils) have high risk of intraocular damage Severe blunt trauma may cause orbital fractures and can also rupture the globe Projectiles pose great risk to the globe, and globe rupture sustained following gun injury often leads to poor visual outcome Hammering, drilling, filing, and nailing are particularly high-risk behaviors for intraocular foreign bodies, especially if safety eyewear use is suboptimal PHYSICAL EXAMINATION Every attempt should be made to examine the eye with the child in a position of comfort in order to minimize agitation, particularly if the history or gross appearance of the eye suggests the possibility of an open-globe injury If the examination is concerning for an open-globe injury, the physician should stop the examination, shield the eye, and consult an ophthalmologist emergently Pain medications and antiemetics can help reduce common causes of elevated intraocular pressure that can lead to further prolapse of intraocular contents