EYE INJURIES OBJECTIVES COMMON EYE EMERGENCIES 7/19/2017 IMPROVE ASSESSMENT OF EYE INJURIES

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1 EYE INJURIES BRITTA ANDERSON D.O. DMC PRIMARY CARE SPORTS MEDICINE ASSOCIATE TEAM PHYSICIAN DETROIT TIGERS OBJECTIVES IMPROVE ASSESSMENT OF EYE INJURIES UNDERSTAND WHAT IS CONSIDERED AN EMERGENCY DEVELOP UNDERSTANDING OF COMMON SIGNS AND SYMPTOMS OF EYE INJURIES KNOW WHEN TO REFER EQUIPMENT FOR SIDELINE BAG/TRAINING ROOM COMMON EYE EMERGENCIES > 100,000 Sports related eye emergencies/year >90% are preventable with proper eye protective wear/precautions #1 cause of blindness in children is trauma Eye exam must be part of a baseline PPE to identify at risk athletes Important to detect vision defects that leaves one of the eyes with greater than 20/40 corrected vision Requires sports eye protectors 1

2 EYE INJURIES SUBCONJUNCTIVAL HEMORRHAGE RETROBULBAR HEMATOMA ORBITAL FLOOR FRACTURE TRAUMATIC IRITIS HYPHEMA RETINAL DETACHMENT RUPTURED GLOBE CORNEAL ABRASION KERATITIS SKELETAL ANATOMY OF FACE BASIC EYE ANATOMY 2

3 EYE ANATOMY SUBCONJUNCTIVAL HEMORRHAGE SUBCONJUNCTIVAL HEMORRHAGE Small blood vessels break beneath conjunctiva Benign No discomfort Caused by heavy lifting, coughing, sneezing, laughing, constipation, or blunt trauma Last about 10 days 3

4 RETROBULBAR HEMORRHAGE RETROBULBAR HEMORRHAGE Rapidly progressive sight threatening emergency that results in an accumulation of blood in the retrobulbar space Increase of blood = increase in intraocular pressure that may result in stretching of the optic nerve and blockage of ocular perfusion Result of orbital trauma Diagnosis: severe pain, proptosis (protrusion of the eyeball), loss of vision, subconjunctival hemorrhage, N/V, periorbital ecchymosis, eye lid hematoma ER 4

5 ORBITAL FLOOR FRACTURE BLOWOUT FRACTURE ORBITAL FLOOR FRACTURE A traumatic injury to the orbital floor/medial wall of the eye socket Signs and symptoms can vary Minimal pain and bruising to very painful. Enopthalmos (severe if >2mm), hypo opthalmia, hypoesthesia to the cheek and upper gum of the affected side Diplopia with limited up and/or down gaze ORBITAL FLOOR FRACTURE Medical therapy warranted if Enopthalmos <2mm Lack of marked hypo opthalmus absence of entrapped muscle or tissue Fracture of <50% of floor Lack of diplopia Oral antibiotics due to disruption of integrity of the orbit in communication with the maxillary sinus. Short course of oral prednisone to reduce edema 5

6 TRAUMATIC IRITIS TRAUMATIC IRITIS Inflammation of the Iris typically due to blunt trauma Trauma to the eye that causes injury and death to cells that subsequently form necrotic products Signs and Symptoms: Decreased visual acuity, conjunctiva injection, possible change in IOP, miosis or mydriasis, photophobia, tears, floaters, pain Topical cycloplegics cause paralysis of the iris and mydriasis rests the iris, reduces pain, prevents synechiae (adhesions of iris to cornea or lens) Topical steroids can be used too Must see specialist TRAUMATIC HYPHEMA 6

7 TRAUMATIC HYPHEMA Pooling or collection of blood inside the anterior chamber (between cornea and iris) Can be painful, blurred vision, photophobia Can increase IOP Typically eye patch, ok to ambulate, and seek medical attention immediately No NSAIDS RETINAL DETACHMENT RETINAL DETACHMENT Retina is a thin layer of light sensitive nerve cells at the back of the eye that help us see clearly Detachment occurs when the retina is pealed away from the support tissue at the back of the eye Is considered a medical emergency Can be caused by trauma 7

8 RETINAL DETACHMENT Photopsia Peripheral flashes of light, usually occurring with eye movement A heavy feeling in the eye Floaters Must seek medical attention if signs or symptoms develop with/after trauma Treated surgically RUPTURED GLOBE RUPTURED GLOBE History of trauma Assess for acute cranial injury first Associated extraocular injury Acute loss of vision or blurred vision Diplopia Usually obvious injury but can be subtle so be aware The most frequent sites of rupture are not easily identified 8

9 RUPTURED GLOBE Avoid any pressure to the eye if globe rupture suspected Visual acuity to both eyes should be done May only be able to do finger recognition at 18inches away or light perception Orbital rim fractures may be present or subcutaneous emphysema Severe subconjunctival hemorrhage 360 degrees around eye may suggest globe rupture RUPTURED GLOBE 360 degrees of subconjunctival hemorrhage RUPTURED GLOBE Treat initially with rigid shield and transport to the ER Impaled foreign bodies should be left alone No eye patch avoid pressure on the eye 9

10 CORNEAL ABRASIONS CORNEAL ABRASIONS Heal with time Prophylactic topical antibiotics given to those with contact lenses Emergent ophthalmologic evaluation warranted for suspected retained intraocular foreign bodies Fluorescein eye exam with blue light KERATITIS 10

11 KERATITIS CAUSES Sleeping in your contact lenses Having microbes build up under the lens HSV Bacteria or fungus Not keeping lenses or cases clean, reusing or topping off contact lens solution Symptoms include blurry vision, redness, pain, tearing, photophobia, foreign body sensation SIDELINE BAG EQUIPMENT Snellen Near Vision Card Fluorescein Strips Penlight or Ophthalmoscope Eye Wash/Antibiotic Drops Cotton Tip Swabs to remove foreign body or every eyelid Fox Eye Shield EYE EXAM Make sure you get a good focused history Symptoms: blurred vision, loss of vision, severe eye pain, floaters/flashers, diplopia External Eye Exam: loss of movement, restrictions, pain with movement Visual Acuity with Snellen Card at 14 Visual Field Monitoring Pupil exam: Irregular shape, anisocoria, Marcus Gunn Pupil 11

12 IMMEDIATE REFERRAL Decreased Vision Loss of peripheral vision Marcus Gunn Pupil / Afferent Pupillary Defect Signs of orbital fracture Diplopia and cheek/gum numbness/nausea Marked light sensitivity Signs of ruptured globe Irregular shaped pupil, anisocoria, brow/dark area on while parte of the eye, hyphema REFERENCES 12