The authors aimed to evaluate aetiologies in paediatric patients presenting to the Wills Eye Emergency department (USA) with particular emphasis on trauma. This was a retrospective review of one-year hospital data; 1136 paediatric patients, 57.4% male, 50.7% white, 36.8% black, 73.3% accompanied by mum. Average age was 10.7 years (two months to 17.9 years). The most common age group was 15-18 years. Lowest presentation period was November to December with a peak between March to June. More than 1300 diagnoses and more than 200 unique diagnoses were made. Most frequent were conjunctivitis (13.4%), abrasions (8.5%), hyphema (8%), lacerations (5.1%), orbital fractures (2.5%), and herpetic disease (2.5%). Infection (19.3%) and trauma (44.4%) were the main categories. Those with trauma included sports / leisure (30.9%) as the most common and motor vehicle accident (1.8%) as the least common. Common sports injuries related to basketball and air guns. Admission was required for 4.9% and 3.9% needed surgery. Discharge on the same day occurred for 95.2%. Most admissions related to trauma (76.4%) with ruptured globe, eyelid lacerations and orbital fractures. The authors conclude this is useful data relating to urban settings and peak variances can be helpful when planning staffing for emergency cover.