Lesson 7:-
Injuries to the eye have not been considered elsewhere in this diploma course. Despite this, injuries to the eye are relatively common – and are largely preventable. It is important to have an awareness of common injuries and to have an approach to managing them. It is very important to be able to recognise indications for further evaluation.
Read more about how to approach an eye injury, or problem, in a football player.
History: The mechanism of injury can help to determine the probability of serious problems being present. High-velocity trauma (such as a punch or elbow to the eye) has the potential to cause a penetrating eye injury or orbit fracture (and should be taken very seriously). Dust from other foreign material falling, blowing or being rubbed into the eye will most likely result in a corneal abrasion. This is a common complaint in beach soccer (where sand frequently causes eye irritation). If there has been no associated trauma, consider possible infectious causes.
Examination: It is essential that the player’s visual acuity is adequately assessed (and documented). Normal acuity does not however exclude injury. The eye should be closely inspected, looking for changes in pupil shape, evidence of bleeding (including conjunctival haemorrhage or hyphaemia). Reactivity to light should also be observed. Eye movements should be checked and visual fields should also be assessed. There may be reduced upwards gaze (due to an entrapped inferior rectus following an orbital floor blowout fracture). Palpate for tenderness and assess facial sensation (a blowout fracture can also cause infra-orbital paraesthesia). The fundus should also be assessed with an ophthalmoscope, although this can be challenging in many football environments.
Treatment: Any player who is found to have reduced acuity, restricted eye movements, severe pain or persisting blurring should be referred for an assessment. Similarly, any player who has a hyphaemia, suspected penetrating injury, globe rupture or who is thought to have a retinal haemorrhage or detachment should be immediately referred for an assessment. More minor injuries, like a corneal abrasion, might be treated with lubricating eye drops, in some cases antibiotic eye drops or ointment or with padding of the eye.
Eye conditions are typically related to trauma, infection or allergic conditions. Dry eyes, especially following international travel, are a common complaint.
You should have equipment to assess and treat eye complaints in your medical bag (or stadium medical room). Suggested medications and equipment include:
- Ophthalmoscope
- Local anaesthetic eye drops (e.g. Minims amethocaine drops)
- Eye patches
- Cotton buds for everting the eyelid
- Chloramphenicol ointments and antibiotic eye-drops (e.g. tobramycin, gentamycin)
- Antihistamine eye-drops (e.g. emadastine difumarate, levocabastine, azelastine hydrochloride)
- Steroid drops (e.g. hydrocortisone, prednisolone, dexamethasone)
- Normal saline drops
- Tears Naturale eye drops
Common Injuries
Clinicians should be aware of the some of the more common eye injuries and have an approach to managing them. Learning the specific details of these injuries is beyond the scope of this course.
Click on the following tabs to read some further information about each of these conditions.
Corneal abrasion, Lacerations Sub-conjunctival haemorrhage, Hyphaemia, Retinal haemorrhage and detachment Penetrating eye injury Orbital injuries.
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