FIGURE 114.7 The bottom of a drinking cup is used as an eye shield Severe eye trauma may cause sedation or vomiting without concurrent head injury Crying and Valsalva maneuvers such as vomiting can result in further extrusion of intraocular contents through the eye-wall opening Every attempt should be made to keep the child calm, including analgesia and antiemetic medications If inter-hospital transport is needed or if calming cannot be achieved, tracheal intubation, sedation, and paralysis can be helpful to keep intraocular pressures as low as possible Broad-spectrum intravenous antibiotic coverage is desirable, but this treatment must be weighed against the potential aggravation of the child with intravenous catheter placement If an intraocular foreign body is suspected, the clinician must establish by history whether it is metallic as this may influence the choice of imaging and treatment Even if an open-globe injury is not seen clearly on examination, any patient who has a high-risk history, severe eyelid swelling, and extreme resistance to examination should be given an eye shield and referred to an ophthalmologist as if an open-globe injury was confirmed BLOW-OUT FRACTURE