Prognosis and management of open-globe injuries in children

Introduction: Open-globe injuries are defined as "full-thickness wounds of the sclera, cornea or both, and have a high likelihood of progression to blindness." Method: After a MEDLINE search, we reviewed articles about open-globe injuries in children that were published in English from 1966 to the present. Results and Discussion: Factors that are generally associated with a poor prognosis in open-globe injuries in children include age less than 8 years, initial visual acuity of less than 20/800 (6/240), injuries from blunt objects, wounds greater than 5 mm or located in the sclera or corneoscleral, and the presence of a foreign body, lens damage, or retinal detachment. Prophylactic intravitreal antibiotics may be indicated for patients who are at high-risk for infection. The role and timing of vitrectomy and of prophylactic scleral buckling in the absence of retinal detachment, and of intraocular lens implantation remain controversial. Conclusion: Despite several advances in the management of children with open-globe injuries, a number of controversial issues remain.