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Iritis
Pictures:
Upon observation the health professional may see the pupil size in the affected eye
decreased, increased, or normal. The red eye appearance is also the norm for this
pathology.
Evaluative Findings:
History:
-The athlete/Patient will complain of blurred vision, sensitivity to light, and a sensation of
pressure.
- The onset may be chronic or Acute
- Iritis may be accompanied by a more serious condition and its pathology must be
determined by a physician-specialist. Bacterial, viral, and blunt trauma to the eye may be
the underlying cause of Iritis.
Palpations:
-In the case of blunt trauma the integrity of the bone surrounding the eye should be
established.
Inspection and Observation:
-Iritis may be accompanied by redness or hyphema-Blood in the anterior chamber of the
eye
-Be sure to establish if the patient uses contacts which may be a possible cause due to
improper cleansing
-Pupil size may be decreased, increased, or the same compared bilateral
ROM:
-Eye movement most likely will not be affected
-If eye movement is effected this may indicate another pathology
Functional Testing:
-Snellen eye chart= vision may be decreased due to blurred vision
-Pupillary reaction test-Involved eye may be sluggish in response to light or
unresponsive- Cranial Nerve III
Injury Management:
-Athlete should be referred to an ophthalmologist
-Treatment may include:
Prescription- eye drops=steroidal, antibiotics,
Sun glasses
Mild analgesics and NSAID’s
Additional Information:
Nontraumatic Iritis may be caused by:
-Ankylosing spondylitis- chronic inflammation in the spine and SI joints may lead to
complete fusion of the vertebrae.
-Sacroidosis-disease that results from inflammation of tissues in the body
-Psoriasis-chronic long lasting skin disease, likely caused by immune system disorder
-Infectious agents may include-Lyme disease, syphilis, herpes simplex virus, and
tuberculosis
Corneal Lacerations
Evaluative Findings
History:
Onset: Acute
CC: “Something in my eye”
MOI: Direct trauma to the eye from a sharp object
Two Types: Partial thickness tear or full thickness tears
Inspection:
Actual laceration can be seen
Watery eyes
Redness
Possible foreign object
Teardrop or elliptical pupil
Functional Tests:
Sensitivity to light
Snellen acuity test (Vision might be blurred due to watery eyes)
Special Tests:
Fluorescein Strips
Cobalt Blue light
FYI:
Mechanisms such as air-bag deployment injury, fingernail scratch, or a seemingly
innocuous popped champagne cork in the eye are rare but can cause a laceration to the
cornea.
Sex: Males are more likely than females to have penetrating ocular injury.
Age: While ocular trauma can occur in persons of all ages, most injuries occur in those
aged 25-30 years.
Corneal Abrasion
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MOI: external force directly striking eye or foreign object (sand or dirt). Contacts
may also cause an abrasion if eyes are rubbed while contacts are in
Pain: over the cornea and the surrounding conjuctiva, normally reported as
"something in my eye."
Inspection: the eyes may water. Conjunctival redness is present. A small foreign
object may be present. Abrasion is not visible under normal conditions.
Functional Test: possible sensitivity to light, possible blurred vision may be due
to scratch on central cornea or increased watering of the eyes.
Special Tests: fluorescein strips and cobalt blue light.
o Symptoms may momentarily clear with blinking as it lubricates the eye;
blurred vision soon returns.
o Immediate referral with eye patch
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Self care at home:
o Flush eyes and use fake tears for lubrication.
o Rest eyes, keeping them closed, as often as possible to help in the healing
process.
Medical treatment:
o Steroid eye drops- decrease inflammation and avoid potential scarring.
o Eye drops for muscle spasm- reduce pain but cause blurred vision
o Anesthetic drops- decrease pain but can only be administered by
ophthalmologist, as a patient will use the drops too often and will not
allow the abrasion to heal.
FYI:
o Recent evidence shows that patching the eye does not help with healing
and may impact the patient negatively.
o If debris in eye is rusty metallic material, a tetanus shot is necessary.
o Wearing contacts with corneal abrasion increases a risk for infection since
the eye will not be exposed to air.
Orbital Fractures
History
Onset: Acute
Pain Characteristics: Orbital margin and
possibly within the eye and orbit.
Asymptomatic or possible complaints of air
escaping from beneath the eyelid.
Inspection
Palpation
Functional Tests
Ligamentous Tests
Neurological Tests
Special Tests
Comments
Mechanism: direct blow to the periorbital
area or globe itself. Blow out fracture
occurs when a blow increases the pressure
within the orbit, causing the orbital floor or
medial wall to fracture.
Ecchymosis and swelling. Eye may appear
sunken inferiorly or posteriorly into the
socket. It may bulge outward or it can be
medially displaced. Laceration of
periorbital or eyelid area is common
Tenderness in the in the periorbital area,
but no tenderness is see with blow out
fractures
Vision: Diplopia is caused by an alteration
in the shape of the orbit or possible to
secondary impingement of the eye's
intrinsic musculature or edema; blurred
vision
Motility: blow out fractures may lead to
the inability to look outward or upward
N/A
Sensory testing of the cheek and lateral
nose for infraorbital nerve entrapment
Radiography, CT scan, or MRI
Refer to ophthalmologist for further
evaluation. If you suspect a blow out
fracture instruct patient not to blow nose.
Management: Fractures that are asymptomatic require ice. Avoid direct pressure on the
globe. If pain is involved during eye movement a plastic or metal shield should be placed
over the eye, again avoiding pressure. Limit motion.
Mortality/Morbidity: The principal morbidity associated with orbital fractures is eye
injury. Associated injuries include corneal abrasion, lens dislocation, iris disruption,
choroid tear, scleral tear, ciliary body tear or bruise, retinal detachment and tear,
hyphema, ocular muscle entrapment, and globe rupture.
Sex: Males are at higher risk of eye injuries because of their increased incidence of
trauma.
Age: For all eye injuries, age distribution has 2 peaks: 10-40 years and older than 70
years.
Conjunctivitis
Evaluative findings:
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Acute onset (morning), may be crusty and stick together
Pn= ichy, burning (actually ‘hurting’ not common)
Poss photophobia
Reddening in involved eye
Poss. Sweeling of eyelid
Discharge common
o Clear=viral (HIGHLY contagious, prolly spread to other eye)
o Yellow/green= bacterial
 GLOVES to palpate!!
o Eyelid is fliud filled and ‘boggy’
 Pos. decreased vision due to swelling, redness and discharge (not able to open the
eye)
 Pos. Hx of contact with some one with red eyes
Immediate care:
 No contact lenses
 No contact sports
 No swimming pool
 Try not to scratch it
 The discomfort of viral or bacterial conjunctivitis can be soothed by applying a
clean cloth soaked in warm water to closed eyes.
 Allergic conjunctivitis can be soothed with a clean cloth soaked in cool water
Allergic conjunctivitis is commonly seen in patients with atopy or hay fever.
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Allergic conjunctivitis
Vernal conjunctivitis
Trachoma
Neonatal conjunctivitis
Acute EKC with significant conjunctival
Acute EKC.
EKC: follicular conjunctivitis.
chemosis.
Antibiotic medication, usually eye drops, is effective for bacterial conjunctivitis. Viral
conjunctivitis will disappear on its own.
Prevention
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Keep hands away from the eye.
Wash the hands frequently.
Change pillowcases frequently.
Replace eye cosmetics regularly.
Do not share eye cosmetics.
Do not share towels or handkerchiefs.
Handle and clean contact lenses properly.
Ruptured Globe
Findings:
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An acute injury usually occurring due to severe blunt trauma to the globe.
Obvious deformity to the globe.
Appearance of deepened anterior chamber.
Black grainy substance visible within anterior chamber.
Elliptical or teardrop shaped pupil may be observed.
Globe contents bulge outward through sclera.
Vision is lost or impaired.
Management:
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Immediate transport to hospital with a shield covering the eye.
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No patch because of extra pressure.
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No food or fluid intake because immediate surgery may be required.
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No eye drops.
Additional Facts:
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Due to occupational and recreational preferences, globe rupture is more
common in males.
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More common in younger patients, with most cases occurring in those
younger than 40 years.
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High percentage of incidence in adolescent boys.
Foreign Bodies
Evaluative Findings:
History :
Onset: Acute
Pain Characteristic : Irritation, possible scratch resulting from object
Mechanism: Most common objects that get in the eye are an eyelash or a piece of dried
muscus. Particulate matter such as sand, dirt, sawdust, or cinders can also be
blown into the eye
Symptoms: Irritation, pain, tears
Inspection: Object may still be present. Redness due to irritation, Possible corneal
abrasion.
Palpation: Not applicable
Functional Tests: Not applicable
Management: Necessary to find object causing discomfort. Can be flushed out using
saline solution. Refrain from rubbing or scratching. Use moist cotton applicator to
remove object
Comments:
~ Foreign objects may lead to corneal abrasions – heal on own in 1-2 days
Extra Fact:
~ Foreign bodies are not the same as impalement of the eye
~ Even contact lens are considered foreign objects
Detached Retina
Retina- sends visual images to brain through optic nerve. When pulled away from
normal position, vision is blurred.
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Detachment almost causes blindness if untreated.
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Retina is pulled by vitreous (clear collagen gel between lens and retina). Peels
retina like wallpaper off wall.
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Predisposing factors:
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Nearsightedness
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Cataract symptoms
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Glaucoma
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Severe trauma
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Family hx of retinal detachment
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Systemic diseases
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Signs/symptoms:
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Floaters
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Gray curtain/veil moving across field of vision
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The longer s/s left untreated, the greater chance of poor/loss of vision
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Tx:
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Surgery to put retina back in place
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Post-op:
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Eye patch for a short time
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May need to change glasses after reattachment
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Vision may take months to improve, but may never fully return
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Extremely nearsighted people have longer eyeballs with thinner retinas and are
more prone to detachment.
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People that are nearsighted and over 40 have 1/20 chance of suffering detachment
in their lives vs. 1/10,000 for the general population.
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