164 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
TREATMENT
- Apply topical broad-spectrum antibiotic and overnight
pressure patch for conjunctival lacerations without evi-
dence for a ruptured globe. Large lacerations may need
suturing, best done by an ophthalmologist. - In cases of suspected corneal laceration, a rigid eye
shield should be placed and the athlete sent for imme-
diate ophthalmology evaluation.
SUBCONJUNCTIVAL HEMORRHAGE
•Very common finding after blunt trauma.
SYMPTOMS
- Generally asymptomatic, but occasionally mild irrita-
tion
EXAMINATION
- Mainly assess for foreign body and ensure no rup-
tured globe present.
TREATMENT
- Reassurance. Most resolve within 2–3 weeks.
•Urgent ophthalmology referral only if extensive hem-
orrhage (nearly 360oaround the cornea).
HYPHEMA
- Bleeding into the AC that can occur after any type of
significant blunt trauma.
SYMPTOMS
•Severe pain and photophobia. Blurry vision if larger
hyphema or associated traumatic iritis.
EXAMINATION
- Perform complete eye examination, including intraoc-
ular pressure. - The blood generally layers, but may see clots or strand-
ing. With slit lamp, can see actual red cells floating,
enabling the identification of a microhyphema.
TREATMENT
- Obtain ophthalmologic consultation, as many will
admit for observation. Emphasize strict bed rest, ele-
vate head of bed to 30o, and eyeshield at all times to
help avoid rebleeding, seen in up to 30%. - Cyclopentolate 1% or atropine 1% tid for pain.
- Daily follow-up by an ophthalmologist to assess for
elevated intraocular pressure and evidence of
rebleeding.
TRAUMATIC IRITIS- Inflammation in the AC that can occur days to weeks
after blunt trauma to the eye. - Same presentation and examination as for hyphema,
but no blood present in AC. - Requires slit-lamp examination to diagnose. If sus-
pected, send for urgent ophthalmologic evaluation.
Definitive treatment involves topical steroid drops.
RETINAL DETACHMENT- May occur after any direct trauma to the orbit, or even
from significant head trauma. More common among
myopic athletes.
SYMPTOMS- Often presents with blind spot in edge of visual field.
Ask about “flashing lights” or new “floaters,” as often
dismissed by the patient. This is important for treat-
ment and prognosis.
EXAMINATION- Check confrontational visual field for defect. Check
for afferent pupillary defect (present with larger
detachments). - Perform fundoscopic examination, but identification
is difficult because it generally begins peripherally.
TREATMENT
•Urgent ophthalmologic consultation for dilated fundo-
scopic examination. Laser treatment for certain retinal
tears or holes, while surgery for detachments.RUPTURED GLOBE/PENETRATING INJURIES- These injuries may occur after any direct trauma to
the orbit, or even from significant head trauma. More
common among myopic athletes.
SYMPTOMS
•Vary with area of involvement. May be asymptomatic
for occult ruptures, present similar to retinal detach-
ment, or with complaints of eye pain or blurry vision.EXAMINATION
•A thorough eye examination is important, but do not
apply pressure to the globe.- Look for a flattened AC, an area leaking gel or fluid
(vitreous or aqueous humor), or darkly pigmented
tissue exposed (uveal tissue). - Presence of 360°subconjunctival hemorrhage strongly
suggests a ruptured globe.