CHAPTER 28 • OPHTHALMOLOGY 165TREATMENT
- Place an eye shield over area and send for immediate
ophthalmologic consultation.
•Keep NPO as may require surgical exploration and
repair.
ORBITAL WALL FRACTURES
- Most often seen after significant blunt trauma.
SYMPTOMS
- Mainly localized pain and swelling to the area. May
have pain with eye movements or diplopia (suggests
extraocular muscle entrapment). If infraorbital nerve
involved, may have numbness on the cheek.
EXAMINATION
•A complete eye examination, with special focus on
extraocular motility, facial numbness, and palpation
of the bony orbits. Rule out ruptured globe.
- Order a computed tomography imaging(CT scan) of
the orbits for definitive diagnosis.
TREATMENT
•Give cefalexin 500 mg qid and oxymetazoline nasal
spray bid for 14-day course (to prevent orbital cellulitis).
- Set up for ophthalmologic evaluation within 7 days.
May require surgical repair if any extraocular muscle
entrapment present. - Hold athlete from any contact until released by oph-
thalmology.
PREVENTION OF EYE INJURIES
PROTECTIVE EYEWEAR
- Eyewear should be made of polycarbonate lenses,
which are up to 20 times stronger than regular pre-
scription glasses (Cassen, 1997; Rodriguez and Lavina,
2003; American Academy of Pediatrics, 1996).
•Should meet American Society for Testing and
Materials (ASTM) standards for specific high-risk
sports (i.e., racquetball, lacrosse, or baseball) (Inter-
national Federation of Sports Medicine, 1998). - If a helmet is required for the sport, then protective
shield may need to be integrated. - Contact lenses offer no protection whatsoever.
- Eye protection can reduce the risk of eye injury by
90% (Rodriguez and Lavina, 2003). - Sports goggles with polycarbonate lenses are recom-
mended for all athletes participating in sports with
higher risk for ocular injury.- Higher risk sports include activities of small, fast
projectiles, hard projectiles, fingers, close contact,
and sticks. - All include sports causing intentional injury such as
boxing, and full contact martial arts.
- Higher risk sports include activities of small, fast
CHOOSING EYE PROTECTION- It is important to know athlete’s vision and eye history.
- Use only eye protectors that have been national certi-
fied and are up to standard.
•Always have professionals assist the athlete in selecting
proper eye protection- Professionals include an ophthalmologist, opto-
metrist, athletic trainer, or optician.
- Professionals include an ophthalmologist, opto-
THE MONOCULAR ATHLETE- Encompasses any athlete with best corrected visual
acuity less than 20/40 in one eye. - Should have thorough ophthalmologic evaluation
prior to allowing participation in sports. - Must be required to wear ASTM approved eye pro-
tection for all practices and games that carry risk for
eye injury. - They should not be allowed to participate in sports in
which no type of eye protection is sufficient (i.e.,
wrestling or boxing). - Monocular athletes should wear polycarbonate lenses
at all times to prevent eye injuries outside of sports.
REFERENCES
American Academy of Pediatrics: Protective eyewear for young
athletes. Pediatrics98:311, 1996.
Cassen JH: Ocular trauma. Hawaii Med J56:292–294, 1997.
Erie JC: Eye injuries: Prevention, evaluation and treatment. Phys
Sportsmed19:108–122, 1991.
International Federation of Sports Medicine: Eye injuries and eye
protection in sports. Br J Sportsmed23, 1998.
Jeffers JV: An ongoing tragedy: Pediatric sports-related eye
injuries. Semin Ophthalmol5:216–223, 1990.
Napier SM, Baker RS, et al: Eye injuries in athletics and recre-
ation. Surv Ophthalmol 40:229–244, 1996.
Rodriguez JO, Lavina AM: Prevention and treatment of
common eye injuries in sports. Am Fam Phys67:1481–1488,
2003.
Vinger PF. Sports medicine and the eye care professional. J Am
Optom Assoc 69:395–413, 1998.
Zagelbaum BM: Treating corneal abrasions and lacerations. Phys
Sportsmed25, 1997.