Common Eye Injuries: Care and Treatment
In competitive athletics injuries to the eye and orbit are not very common, but when they occur, one should be prepared to treat them properly. If an eye injury is treated improperly, the result could be a loss in visual acuity or the permanent loss of sight in the affected eye. If an athlete looses an eye, many physicians will not allow him/her to resume any sports utilizing a thrown implement, hit ball, or collision or contact sports like football and basketball. For this reason, proper treatment of eye injuries is paramount.
The eye is protected by the orbit; it is composed of the lower edge of the frontal bone of the skull, the maxilla, and the nasal bones. The bones of the orbit are thin extensions of the bones surrounding the orbit. The eye is protected in front by the eye lids, eye lashes and the conjunctiva. The conjunctiva is a thin membrane covering the eyeball. The eyeball is spherical in shape, approximately one inch in diameter.
The cornea is the surface that covers the front of the eye; it is clear and transparent to allow light to enter the eye. The white portion of the eye is called the sclera. The iris is the colored portion of the eye, and controls the amount of light that can enter the eye. As the amount of light decreases the pupil becomes larger, allowing more light to enter the eye. The space between the iris and the cornea is called with anterior chamber and is filled with the aqueous humor. The aqueous humor is very water-like in consistently.
Located behind the iris is the lens of the eye, it focuses light onto the retina. The retina is a layer of cells that changes the light image into electrical impulses. These impulses are carried to the visual cortex in the brain for interpretation of the image. The inner cavity of the eye is filled with a clear gel called the vitreous humor.
The eye is most commonly injured by a foreign object. A foreign object is any hard or liquid substance that is not indigenous to the eye. A foreign object can be anything from a small piece of dirt, to another athlete’s finger, to acids. If the object is small and not imbedded in the eye, it should be washed out with water or saline. Saline is preferable since it is the same fluid that bathes the eye. If saline is not available use simple tap water and continue to wash the eye until it feels clear of the object.
In some instances, the foreign object may become trapped behind the eyelid. To remove these objects is may be necessary to flip the eyelid up to visualize and remove the object. Figures 2 and 3 demonstrate using a cotton tipped applicator to assist in flipping the eye lid up to facilitate washing of the eye. When attempting to remove a foreign object DO NOT place any material (cotton, gauze, your finger, etc.) on the eye ball. Material that may feel soft to the touch is still abrasive enough to damage the cornea. If the object is located on the lid of the eye a cotton tipped applicator can be used to remove it.
If it is suspected that the foreign body has caused an abrasion, an optometrist or ophthalmologist needs to be seen. An abrasion of the cornea, when untreated, can result in an infection, or a loss of visual acuity. The physician will use a special light and substance called fluorescein placed in the eye to visualize the abrasion. If the cornea is abraded, the physician will usually prescribe an antibiotic drop.
Any time that there is a suspected eye abrasion or visible laceration, the athlete needs to be referred to an eye care specialist. If the family physician is used only if the eye care specialist is unavailable. This is a matter of specialization, eye care specialists are current on proper treatment protocols, and medications relating to eye injuries. The family physician does not have the ability to keep current in all treatment changes for all types of injuries.
Another common eye injury is a periorbital contusion or black eye. These injuries are caused by blunt trauma and need little care other than observation and ice to control the swelling. Remember to never place ice directly over the eye, always have a cloth between the eye and ice bag. The eye should be checked if there is degrading vision, or the swelling is uncontrolled.
With exercise it is common to have a subconjunctival hemorrhage, or bleeding in the white of the eye. This is caused by an increase in pressure within the body. The most common cause is improper breathing techniques while lifting weights. If the lifter does not exhale as he is lifting the weight, the increase in pressure within the abdomen and thorax will cause blood pressure to surge. This surge in blood pressure is felt more so in the small blood vessels, such as in the eye. The condition is characterized by a patch of blood in the white of the eye. This condition usually resolves itself just as any contusion would. This injury can also be caused by blunt trauma the eye. If the area is large enough, or the blow to the eye was severe enough, other components of the eye may be damaged.
Boxing has brought to light the subject of retinal detachment. The retina is the layer of tissue in the back of the eye. If there is a blow to the eye, this layer of tissue can become detached from the back of the eye. This manifests it self by many varied symptoms from “floaters” or a “snow storm” effect, to flashing lights (photopsia), to “hooded vision.” “Hooded vision” is similar to putting blinders on a horse. This is due to the retina peeling off of the eye and falling down resulting in obstructed light transfer onto the remaining retina. This is a serious medical problem that will not resolve itself and is usually treated surgically.
Infections in the eye are fairly common medical problems as well. These need to be treated aggressively with the proper antibiotics prescribed by an eye care specialist. The most common is “pink eye” or conjunctivitis. In many cases, this problem is caused by the placement of bacteria in the eye by our own hands. For example, little Johnny picks at his nose, then rubs his eye with the same finger. This can transfer the normal bacteria of his nasal passage to his eye, where it is not normal bacteria. The environment of the eye (warm, and dark for 6 - 8 hours a day) is a perfect culture media for bacteria. This is why eye infections can go from very mild to severe over night.
©2000 - 2009 David Edell
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Last Update for AthleticAdvisor.com: 10/24/2009 12:09:35 AM