Beruflich Dokumente
Kultur Dokumente
Pathologies
Orthopedic Assessment III – Head,
Spine, and Trunk with Lab
PET 5609C
Clinical Evaluation
History:
Location and Description of the Symptoms:
Complaints of scratchiness or “something in the eye”
Foreign body
Displaced contact lens
Corneal Abrasion – painful scrape or scratch of the corneal
epithelium
Photophobia
Intolerance to light
Itching of the eye
Chemosis – edema of the conjunctiva
Allergies
Clinical Evaluation
Photophobia – sensitivity to light
Greater Risk: People with…
Lighter-colored eyes
Cataracts
Migraine headaches
Often a symptom of another
underlying problem:
Corneal abrasion
Uveitis
Meningitis
Retinal detachment
Contact lens irritations
Often accompanies:
Albinism
Total color deficiency (seeing grey)
Botulism, rabies
Conjunctivitis, keratitis and iritis
Clinical Evaluation
Mechanism of Injury:
Striking Object:
Size / Elastic properties
Basketball, baseball, golf
ball
Head, elbow, fist, finger
Chemicals / Foreign
Substances:
Dirt and sand
Lime (playing field)
Mechanism of Injury
Size Relative Elastic Resulting Pathology
to the Orbit Property
Larger Hard Orbital fracture, periorbital contusion
Nasal Bone
Zygomatic bone
Functional Testing
Vision Assessment:
Performed one eye than with both
eyes
Prescribed glasses/contacts worn
during assessment
Findings:
Diplopia – double vision
Can indicate orbital fracture, brain
trauma, damage to optic or cranial
nerves
Blurred vision
Loss of portions of visual field
“A shade is being pulled over the
eye”
Can indicate a detached retina
Functional Testing
Myopia:
Nearsightedness
Light rays converge at a
point before reaching the
retina instead of focusing
on the retina
Only the objects close to
the eyes are
distinguishable
Distant objects hard to
see
Most common vision
problem worldwide
Emmetropia - 20/20 Vision:
Ability to read the letters on the 20 ft line of an eye
chart when standing 20 ft from the chart
Functional Testing
Hypermetropia:
Farsightedness
Distant object
becomes focused
behind the retina
Close objects appear
out of focus and may
cause headaches, eye
strain, and/or fatigue
Squinting, eye
rubbing, difficulty in
reading
Functional Testing
Pupil Reaction to Light:
Penlight - shine light into pupil for 1
sec. with opposite eye covered
Observe for pupil restriction and
dilation
Repeated on opposite eye
Positive Test:
Pupil unresponsive to light
Pupil sluggish compared to opposite
side
Indicative of mechanical or
neurological deficit of iris
Head Injury
Functional Testing
Functional Testing
Inspection of Eyes – Head
Injury
Eyes appearance
Dazed, distant
Nystagmus – involuntary
cyclical movement
Pressure on eyes’ motor nerves or
disruption of inner ear
Pupil Size
Are they equal?
Unilaterally dilated pupil →
intracranial hemorrhage (pressure
on cranial nerve III)
Anisocoria – unequal pupil size
(may be normal for athlete –
preparticipation exam)
Pupil Reaction to Light
Functional Testing
Eye Motility Test:
Eyes ability to perform complete sweep
of ROM (smooth and symmetrical)
ATC stands in front of athlete and holds
finger 2 ft. from patient’s nose
Evaluation Procedure:
Patient focuses on finger and reports any
double vision
Finger moved ↑, ↓, →, ←
Finger moved through diagonal fields
Positive Test:
Asymmetrical tracking
Double vision
Neurological Testing
Cranial Nerve II – Optic
Vision Assessment → Snellen’s
Chart
Cranial Nerve III –
Oculomotor
Assessment:
Pupil reaction to light
Elevation of upper eyelid
Eye adduction and downward
rolling
Cranial Nerve IV – Trochlear
Assessment:
Upward eye rolling
Cranial Nerve VI – Abducens
Assessment:
Lateral eye movement
Eye Pathologies
Orbital Fractures:
MOI: blow from an object
that is usually larger than the
orbit (frontal, zygomatic,
maxillary bone)
↑ intraorbital pressure – orbital
bones break at weakest point
Compression of inferior orbital
rim causes direct buckling of
the floor
Blow-out fracture – fx. of
medial wall or floor Object striking the eye causes
Blow-up fracture – fx. of the globe to expand downward,
rupturing the orbital floor.
orbital roof
Eye Pathologies
Orbital Fractures:
Inspection:
Ecchymosis, swelling
Eye may appear sunken
inferiorly or posteriorly into
the socket
Eye may bulge outward or be
medially displaced
Associated lacerations
Palpation:
Possible tenderness in
periorbital area
Possible numbness in lateral
nose and cheek (infraorbital
nerve entrapment)
Eye Pathologies
Orbital Fracture:
Functional Testing
Vision:
Diplopia
Blurred vision
Eye Motility:
Limited ability to look
upward – entrapment of
the inferior rectus muscle
Eye Pathologies
Orbital Fracture:
Neurological Testing:
Sensory testing of the cheek and
lateral nose (entrapment of
infraorbital nerve)
Special Tests:
X-rays
CT scan
MRI
Special Note: Athlete should
refrain from blowing nose Radiograph of blow out fracture
Air escapes nasal passage, to the left orbit, with inferior
enters the orbit, and exits from orbital contents herniating into
under the eyelid the maxillary antrum (arrow)
Eye Pathologies
Corneal Abrasion –
Scratching of the eye
MOI:
External force striking
the eye
Finger (poked in eye)
Foreign object in eye
Sand, dirt, paint chip
Contact lenses – wearing
longer than
recommended
Athlete reports feeling of
“something in the eye” Note: Under normal conditions,
the abrasion is not visible to the
unaided eye.
Eye Pathologies
Corneal Abrasion:
Inspection:
Tearing (attempt to wash particles from eye)
Conjunctival redness
Presence of foreign object
Functional Tests:
Sensitivity to light
Blurred vision
May be secondary to eye watering
Special Tests:
Fluorescent strips and cobalt blue light
Only cells suffering the abrasion will absorb the dye
Eye Pathologies
Fluorescent Dye Test:
Procedure:
Soak the fluorescent strip
with saline
Lightly tough the strip to
the conjunctiva of the
lower eyelid (hold for a
few seconds)
Have patient blink a few
times – will spread the
dye
Darken room, use cobalt
blue light
Eye Pathologies
Corneal Abrasion:
Immediate Referral:
Patch the eye
Refer to physician
Eye Pathologies
Corneal Laceration:
Partial – does NOT violate
the globe
Similar signs/symptoms of
abrasion
Actual trauma may be
visible
Full-Thickness –
penetrates through the
cornea
Aqueous humor may escape
the anterior chamber
Cornea may appear flat
Irregular shaped pupil
(teardrop distortion)
Eye Pathologies
Iritis – inflammatory reaction within anterior
chamber; “Red Eye” appearance
MOI:
Blunt trauma (traumatic iritis)
Nontraumatic iritis – frequently associated with
certain systemic diseases (tuberculosis, inflammatory
bowel disease, psoriasis)
Infectious causes – Lyme disease, TB, syphilis,
herpes simplex
Eye Pathologies
Iritis: Symptoms
Pain
Photophobia
Blurred vision; headache
↑ tear production
Functional Testing:
Sluggishly reactive to light
Neurological Testing:
Cranial Nerve III
Pupil reaction to light
Note: Refer to
Ophthalmologist
Eye Pathologies
Detached Retina:
Anatomy review: Retina - nerve layer at the back of your eye (senses
light and sends images to your brain)
Does not work when detached; almost always causes blindness if left
untreated
MOI:
Jarring force to the head
Aging Process - As we age, the vitreous (clear gel that fills the eye) can
pull away from its attachment to the retina at the back of the eye
Usually will separate without causing problems
If it pulls hard enough it can tear the retina
Fluid may pass through the tear - lifting the retina off the back of the eye
Increased risk for retinal detachment:
Nearsighted or family hx.
Previous cataract surgery or glaucoma
Previous retinal detachment (other eye)
Eye Pathologies
Detached Retina:
Symptoms
Flashing lights
New floaters
Description of a “Gray
curtain moving across field
of vision”
Treatment:
Almost all patients with
retinal detachments require
surgery
Eye Pathologies
Ruptured Globe:
Most catastrophic injury to eye
MOI:
Severe blunt trauma (orbital rim dissipates little/no force)
Resulting rupture of cornea/sclera
Contents are spilled
Inspection:
Deformed globe / Deepened anterior chamber
Hyphema
Presence of black, coffee-ground like substance within
anterior chamber (spilled contents of globe)
Eye Pathologies
Ruptured Globe:
Treatment:
Immediate
transportation to
hospital
Cover eye with shield
Do NOT administer
any eye drops or allow
athlete to eat/drink
Immediate surgery may
be needed
Eye Pathologies
Conjunctivitis:
Result of viral/bacterial infection of conjunctiva
Inflammatory causes such as chemicals, fumes, dust, and debris
Allergies
Injuries
Oral genital contact with someone who might be infected with a
sexually transmitted disease (STD) such as chlamydia,
gonorrhea, or herpes
Onset/Description of Symptoms:
1st thing in morning – eyelids may stick together
Itching, burning
Inspection:
Discharge:
Clear, watery – viral infection (Pink Eye)
Yellow or green – bacterial infection
Eye Pathologies
Conjunctivitis:
Functional Tests:
Impaired vision
Special Notes:
Highly contagious
Infected person – no
physical contact with other
athletes
Treatment:
No contact lenses
Refer to physician
Eye Pathologies
Foreign Bodies:
Usually benign
Clears once object is removed
Removal:
Flushed with saline or water
Moistened cotton applicator may be used
Do NOT use dry cotton
Instruct athlete to avoid rubbing the eye
Eye Pathologies
Penetrating Eye Injuries:
Do NOT attempt to
remove the object
Do NOT apply direct
pressure on the eye
Shield the eye
If object is protruding far
from the eye, use a
paper/plastic cup to cover
Immediate transportation
to hospital
Eye Pathologies
Chemical Burns: Eye Shields:
Rinse eye with large Protection of the eye
amounts of saline for transport
and/or water Athlete should be
Patch the eye instructed to close the
uninvolved eye or look
Transport immediately straight ahead
Eyes move in unison
Contact Lens Removal
Hard Lenses Removal:
Open eyes wide
Laterally pull outer margin of
eyelids
Patient blinks, forcing lens out
Soft Lenses Removal:
Patient looks up
Clean finger placed on inferior
edge of lens
Lens manipulated inferiorly and
laterally
Pinch between fingers