Incidental Ocular Trauma by Pencil and Pen in Children

To determine features of eye trauma associated with self-trauma by pens and pencils among children.

Thirty-six children suffering from self-inflicted eye trauma with pens or pencils were included in this prospective cross-sectional study.

The age range of the participants was 2-14 years with an average of 5.6 years and a standard deviation of 2.7, with a male: female ratio of 1.76. The superomedial (55.5%) and inferomedial (30.6%) quadrants were the most common sites of injury. The leading culprit was colored pencils (44.4%). During surgical exploration, no foreign body (FB) was found in 25 (69%) patients while an FB was found in 11 (30%) patients. Brain injury was present in two patients (5.6%) and only in superomedial quadrant injuries. Zone 1 was the most common site for ocular trauma associated with penetrating injury. The mean ocular trauma score (OTS) in penetrating injuries was 3.8±1.2. The best-corrected visual acuity (BCVA) was 0.34±0.61 upon admittance and 0.08±0.21 after one year. The final BCVA was significantly correlated with the entrance site, better final BCVA was found in nasal entrance site.

The ophthalmologists should keep a high index of suspicion to rule out penetrating eye injuries related to writing instruments in a young uncooperative child. Brain injury is a life-threatening event that should be ruled out by appropriate imaging. Medial canthal area as the most common site needs especial attention in writing instrument injuries.