Download Chapter 18 - Eye Pathologies

Chapter 18
Eye Pathologies
Copyright © 2015. F.A. Davis Company
Clinical Anatomy
 Identify
 Bony anatomy
 Orbit
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Sphenoid
Lacrimal
Ethmoid
Palatine bone
 Orbital margin
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Frontal bone
Zygomatic bone
Maxillary bone
Superior orbital
fissure
 Optic canal
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Eye Structures
 Identify
 Globe
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Sclera
Pupil
Iris
Conjunctiva
Cornea
Lens
Retina
Choroid
Rods and cones
Optic nerve
 Eyelids
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Muscular Anatomy
 Identify
 Rectus muscles
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Inferior
Medial
Lateral
Superior
 Oblique muscles
 Inferior
 Superior
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Visual Acuity
 Visual acuity—quality of vision
 Snellen eye chart
 Emmetropia—20/20 vision
 The athlete’s ability to read at 20 ft what a
normal person could read at 20 ft
 20/40—The athlete’s ability to read at 20 ft
what a normal person could read at 40 ft
 Myopia—nearsightedness
 Hypermetropia (hyperopia)—
farsightedness
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Clinical Examination of Eye Injuries
 Evaluation map
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History
Inspection
Palpation
Functional assessment
Neurological examination
Pathologies and special tests
Copyright © 2015. F.A. Davis Company
Evaluation Supplies Needed for Eye
Injuries
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Snellen chart or similar
Occluder
Penlight
Cobalt blue light
Small mirror
Fluorescein strips
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Management Supplies Needed for
Eye Injuries
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Eye shield
Eye patch
Tape
Plunger for removing
hard contact lenses
 Sterile saline solution
 Sterile cotton swabs
and gauze
 Antibiotic eyedrops
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 Steri-Strips™ or
butterfly bandages
 Contact information of
consulting
ophthalmologist
 Contact information of
hospital or poison
control center
History
Past medical history
 Prior visual assessment
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Prior visual acuity?
Corrective lenses?
Nystagmus?
Previous injuries?
Preexisting conditions?
 General health
 Chronic illness (e.g.,
diabetes—retinopathy)
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History of the present
condition
 Location and description
of symptoms
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Photophobia?
“Something in my eye”
Foreign body
Displaced lens
Corneal abrasion
“Itchy”
 Chemosis
 Injury mechanism
Blunt Eye Trauma and the Resulting
Eye Pathology*
Size Relative to
the Orbit
Elastic Property
Resulting Pathology
Larger
Hard
Orbital fracture, periorbital
contusion
Larger
Elastic
Blowout fracture, ruptured
globe, corneal abrasion,
traumatic iritis, periorbital
contusion
Smaller
Hard
Ruptured globe, corneal abrasion,
corneal laceration, traumatic iritis
Smaller
Elastic
Ruptured globe, blowout
fracture, corneal abrasion,
traumatic iritis
*All of these mechanisms of injury can result in subconjunctival hemorrhage and retinal
pathology.
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Inspection
 Trauma to external structures may mask
underlying pathology.
 A normal external eye may still have
internal damage.
 Immediate referral findings
 See Table 18-4 in the text
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Inspection of the Periorbital Area
 Discoloration
 Hematoma
 Gross deformity
 Gross bony deformity
 Skin surrounding eye swells easily
 Lacerations
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Inspection of the Globe
 General appearance
 Enophthalmos
 Exophthalmos
 Eyelids
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Swelling
Ecchymosis
Lacerations
Stye
 Cornea
 Cloudiness = intraocular
pressure
 Hyphema
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Inspection of the Globe
 Conjunctiva
 “Teardrop” pupil
 Foreign body
 Subconjunctival hematoma
 Sclera
 Black object may be the inner
tissue of the bulging out
 Iris
 Iritis
 Pupil shape and size
 Anisocoria
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 Corneal laceration
 Ruptured globe
Palpation
 Bony structures
 Orbital margin
 Frontal
 Nasal
 Zygomatic bones
 Soft tissue
 Eyelid and skin
surrounding the eye
GLOBE
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Functional Assessment
Vision assessment
 Devices
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Snellen eye chart
Near-vision card
Newspaper
Game program
Fingers
 Monocularly (one eye)
 Binocularly (both eyes)
 Wear corrective lenses at
the time of assessment
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Pupillary reaction to light
 Dysfunction
 Dilation
 Diminished PEARLA
 Indicates
 Head trauma
Eye motility
 Smooth, symmetrical
ROM
Selective Tissue Test: Assessment
of Eye Motility
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Snellen Eye Chart
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Neurological Testing
 Cranial nerves III, IV, and VI
 Infraorbital nerve
 Numbness of the cheek and lateral nose
 Orbital floor fracture
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Eye Pathologies
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Orbital fractures
Corneal abrasions
Corneal lacerations
Iritis
Hyphema
Retinal detachment
Ruptured globe
Conjunctivitis
Foreign bodies
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Orbital Fracture
 Blowout fractures
 Medial wall and floor
fracture
 Blow-up fractures
 Orbital roof fracture
 Management
 Ice packs if
asymptomatic
(besides pain)
 If pain with movement
 Shield eye
 “Look straight ahead”
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Hyphema
 Blood in the anterior
chamber of the eye
 MOI
 Blunt trauma
 Spontaneous
 Management
 Patching or shielding
 Referral to ER
 Usually resolves in 5
to 6 days
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Retinal Detachment
 MOI
 Jarring force to the head
 Sneezing
 Spontaneous
 Marfan syndrome
 Signs and symptoms
 Flashes of light, halos, or blind spots
 “A curtain came down”
 Management
 Often requires surgery
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Copyright © 2015. F.A. Davis Company
Foreign Bodies
 Management
 Attempt to find the body
 Flush out with saline
 Wet cotton applicator or gauze to blot out body
 “Do not rub your eye”
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Contact Lens Removal
 Remove ASAP after injury
 Ask athlete to remove lens
 Hard contact lens removal
 Open the patient’s eyes as wide as possible.
 Pull laterally on the outer margin of the
patient’s eyelids.
 While holding a hand under the eye to catch
the lens, the patient blinks, forcing the lens
out of the eye.
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Contact Lens Removal
 Soft contact lens removal
 Have the patient look upward.
 Place a clean finger on the inferior edge of the
contact lens.
 Manipulate the lens inferiorly and laterally.
 Pinch the lens between the fingers and safely
remove it from the eye.
 Ensure all pieces are removed from the eye.
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Penetrating Eye Injuries
 Management
 Never attempt to remove the object
 Cover and protect the eye
 Cup
 Cover both eyes to minimize movement
 Transport to ER
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Chemical Burns
 Management
 Irrigate eye with saline or water
 Patch the eye
 Transport to ER, with sample of chemical
Copyright © 2015. F.A. Davis Company