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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 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 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: 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. 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 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: 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: Immediate transport to hospital with a shield covering the eye. No patch because of extra pressure. No food or fluid intake because immediate surgery may be required. No eye drops. Additional Facts: Due to occupational and recreational preferences, globe rupture is more common in males. More common in younger patients, with most cases occurring in those younger than 40 years. 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. Detachment almost causes blindness if untreated. Retina is pulled by vitreous (clear collagen gel between lens and retina). Peels retina like wallpaper off wall. Predisposing factors: o Nearsightedness o Cataract symptoms o Glaucoma o Severe trauma o Family hx of retinal detachment o Systemic diseases Signs/symptoms: o Floaters o Gray curtain/veil moving across field of vision o The longer s/s left untreated, the greater chance of poor/loss of vision Tx: o Surgery to put retina back in place o Post-op: Eye patch for a short time May need to change glasses after reattachment Vision may take months to improve, but may never fully return Extremely nearsighted people have longer eyeballs with thinner retinas and are more prone to detachment. 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.