If no lens can be identified, then likely migrated into the upper fornix.

Instilling fluorescein into the eye will stain the lens and make it easier to locate.

Pseudomonas aeruginosa and Acanthamoeba polyphaga most common in contact lens,  
topical fluoroquinolones are the antibiotic of choice.
Uveitis in patients with JIA can cause acute angle-closure glaucoma, including sudden onset
of severe eye pain, decreased vision, conjunctival injection with ciliary flush, and a midsized,
poorly reactive pupil. Need for IOP measurement.

Medical dilation, placing the patient in a darkened room, and patching are contraindicated,
as any intervention that causes pupillary dilation can worsen intraocular pressure by further
closing the angle and impeding aqueous humor flow from the anterior chamber.

The patient should be placed supine so that gravity can cause the lens to fall away from the
iris and possibly improve aqueous flow through the angle.

Acute angle-closure glaucoma must be recognized and treated quickly, as permanent vision
loss can result within hours of the acute presentation.
Contact Lenses
Ruptures Globe
Tear drop pupil
If pupils looks normal but appears sluggish - can preform fluorescence exam and look for
extravasation of dye
Treatment - Keep calm, Elevate head of bed, Place eye shield, Call optho
IV abx are given to prevent endophthalmitis

Blood in the anterior chamber (between the iris and cornea)
Treatment Eye shield -Elevate the bed to 30 degrees  - IV morphine and Zofran - Call Optho
Treatment – prevents Glaucoma

Orbital Blowout Fracture
Pain with palpation of the orbital rim – risk entrapment – inferior rectus – no upward gaze

Traumatic Iritis  
Acute painful red eye - Blurry vision – Photophobia – Tearing
Cillary flushing – reddening of the sclera at the limbus
Eye Injury
Ranges from contusion with a small hyphema to rupture of the globe with uveal prolapse,
traumatic iritis, traumatic keretitis retinal hemorrhage and detachment, optic nerve contusion,
glaucoma and retinal Injury, eye enucleation and intracranial penetration.

Immediate pain could be due to corneal Ulceration.
BB Gun or Pellet related Eye Injury
Globe rupture
Clinical findings include tear drop pupil, 360-degree subconjunctival hemorrhage or edema,

If any of the above is present, immediately place an eye shield, not patch, analgesia,
antiemetics, antibiotics  and minimize disturbing the child

Further ocular examination should be stopped immediately and no eye drops should be instilled.