Sports Medicine: Just the Facts

CHAPTER 28 • OPHTHALMOLOGY 163

• Pupils:Using a bright light source, check to ensure
  pupils are round, symmetric, and reactive.


• Extraocular muscles:Ensure full range of motion,
  especially looking for significant asymmetry.


• External Examination:This includes examination of
  the bony orbits, eyelids, adnexal structures, periorbital
  skin, and conjunctiva, cornea, anterior chamber(AC),
  and iris.
  
  
  1. Conjunctiva and sclera: Here pay close attention
     for signs that suggest a ruptured globe, including
     lacerations, 360°subconjuctival hemorrhage, or
     extruding pigment (uveal tissue) or gel (vitreous
     humor).
  
  
  2. Cornea: Assess for clarity, then apply fluorescein
     to identify epithelial defects or foreign bodies.
     3.Anterior chamber: Ensure the chamber is well-
     formed, comparing to unaffected side. Look
     closely for any blood present in the anterior
     chamber.
  
  
  
  


• Fundoscopic examination: This should be performed
  in all cases of eye trauma, paying special attention to
  the red reflex. Asymmetry in the red reflex is often a
  subtle clue to the presence of significant pathology.


• Other: Although slit-lamp examination is ideal for all
  cases of ocular injury, it is generally not available. As
  such, it is often deferred for more serious cases that
  require evaluation by an ophthalmologist.

COMMON EYE INJURIES

EYELID LACERATIONS

• Seen after blunt or sharp trauma to the area. May also
  be indirect from broken spectacles.

SYMPTOMS

• Localized pain and bleeding around the eye

EXAMINATION

• Check for involvement of the lid margin. Assess the
  depth of the laceration, to see if orbital fat is exposed.
  If lesion is medial, assess if it involves the lacrimal
  drainage system.


• Perform thorough eye examination to ensure globe is
  not injured.

TREATMENT

• Clean area with betadine and inject lidocaine for local
  anesthesia. Then explore wound for foreign body, irri-
  gate with normal saline or Lactated Ringer’s solution
  and suture using 5-0 nylon. Apply antibiotic ointment
  to area and apply protective eye shield. Remove suture
  in 7–10 days.
  
  
  • Lacerations suspected of involving the lacrimal
    drainage system, full-thickness lacerations, exposure
    of orbital fat, and those involving the lid margin
    require immediate ophthalmology referral.
  
  
  
  

CORNEAL ABRASIONS

• One of the most common sports-related eye injuries
  (Zagelbaum, 1997), accounting for 33% of all eye
  injuries seen in Major League Baseball and 12% of
  these seen in the National Basketball Association
  (Zagelbaum et al, 1994; Zagelbaum et al, 1995).

SYMPTOMS

• Sharp pain, photophobia, foreign body sensation, and
  tearing

EXAMINATION

• Check visual acuity. Then apply fluorescein stain,
  preferably with topical anesthetic and assess using a
  cobalt blue light. The pain should improve with the
  topical anesthetic. Any epithelial staining confirms
  the diagnosis.


• Flip upper and lower lid to search for foreign body, if
  suspected from mechanism.

TREATMENT

• Apply topical broad-spectrum antibiotic and follow
  daily until epithelial defect resolved. For larger
  lesions, a pressure patch can be applied overnight.
  •For patients with significant photophobia, prescribe
  1% cyclopentolate tid for 2–3 days.

CORNEAL/CONJUNCTIVAL LACERATIONS

SYMPTOMS

• Mild pain and foreign body sensation for conjunctival
  lacerations.
  •Severe pain, tearing, and blurry vision for corneal lac-
  erations.

EXAMINATION

• Conjunctival: Often see area of subconjunctival
  hemorrhage. Fluorescein stain may show area of tear.
  Perform complete eye examination, especially look-
  ing for scleral laceration, other evidence for ruptured
  globe, or a conjunctival foreign body.


• Cornea:Best viewed with a slit-lamp, but may sus-
  pect from penlight examination. Especially look for
  a flat AC, irregularities of the iris, or fold in the
  cornea.