Traumatic eye injury
Including superficial eye injury, penetrating eye injury and orbital blow out fracture.
Treat for 7 days. If foreign body remains in situ, discuss duration of treatment with Paediatric ID.
Urgent ophthalmology discussion required
In the case of confirmed or suspected CNS penetration, see Penetrating intracranial injury / gunshot - contaminated neurosurgery
Superficial trauma - corneal abrasion
Preferred
chloramphenicol eye ointment (1%) QDS
Alternative (preferred in contact lens wearers and/or those with an allergy to chloramphenicol)
ofloxacin eye drops (0.3%) 2 hourly for 2 days then reduce to QDS for 7 days
Blowout fracture, penetrating injury, intraocular foreign body, or corneoscleral wound
Preferred (including non-severe and severe penicillin allergy)
co-trimoxazole po, see dosing table
|
Age |
ORAL co-trimoxazole dose |
|
6 Weeks to 5 Months |
120mg BD |
|
6 Months to 5 Years |
240mg BD |
|
6 Years to 11 years |
480mg BD |
|
12 years to 17 years |
960mg BD |
If contaminated with soil or excreta: ADD metronidazole
| Age | ORAL metronidazole dose |
| 1 month | 7.5mg/kg (Max 400mg) po BD |
| 2 months – 11 years | 7.5mg/kg (Max 400mg) po TDS |
| 12 years and over | 400mg po TDS |
If unable to tolerate orals, give IV metronidazole:
|
Age |
INTRAVENOUS metronidazole dose |
|
1 month up to 2 months |
Loading dose 15 mg/kg (Max 500mg) iv, then (after 8 hours) 7.5 mg/kg (Max 500mg) iv TDS |
|
2 months to 17 years |
7.5mg/kg (Max 500mg) iv TDS |
If corneal abrasion present: Consider adding chloramphenicol eye ointment (1%) QDS
Alternative
Speak to Paediatric ID if the above treatment options are contraindicated.
Additional Comments
After safety concerns regarding boron exposure in children under 2 years of age, a MHRA Review (2022) concluded that chloramphenicol eye drops containing borax or boric acid can be safely administered where treatment is indicated