can be more difficult to “trick.” Sometimes, by placing a drop of saline or topical anesthetic in the eye while giving the child the suggestion that these “magic drops” will cause a return of vision, the child then begins to see better The pinhole test (discussed above) can also be used in this manner Ophthalmology consultation is sometimes critical in discovering whether a child has truly sustained visual loss Rarely, transient cortical visual impairment/blindness can result following direct or contrecoup blunt occipital head trauma Despite an otherwise normal eye examination, centrally mediated vision loss may occur Though the vision loss may be transient, ophthalmology should be consulted Traumatic cataract, vitreous hemorrhage, commotio retinae (bruising and edema of the retina from blunt injury), retinal detachment, and optic nerve injury may also cause acute traumatic vision loss For these injuries, ophthalmology consultation is also required The most effective screening tests for severe intraocular injury remain visual acuity testing, evaluation of the pupils for direct, consensual responses as well as relative afferent pupillary defects, inspection of the anterior segment, and examination of the red reflex (with or without direct ophthalmoscopy) Child Abuse Virtually, any eye injury can be the result of child abuse Perhaps the most common ocular manifestation of child abuse is the finding of retinal hemorrhages associated with the abusive head injury ( Fig 114.11 ) Although these hemorrhages can be seen with the direct ophthalmoscope, ophthalmology consultation is required Children who present to the ED before the age of years with significant intracranial hemorrhage, unexplained skeletal fractures, or sudden, unexplained cardiorespiratory arrest should have a full dilated examination conducted by an ophthalmologist to look for retinal hemorrhages that may indicate that a nonaccidental injury has occurred Suggested Readings and Key References General Approach to Ocular Trauma Chapter 8: Pediatrics In: Bagheri N, Wajda BN, eds The Wills Eye Manual— Office and Emergency Room Diagnosis of Eye Disorders 7th ed Philadelphia, PA: Wolters Kluwer; 2017:177–203 Levin AV Eye emergencies: acute management in the pediatric ambulatory setting Pediatr Emerg Care 1991;7:367–377