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Eye Anatomy - Globe

  • Cornea: protects the eye and helps focus light rays on the retina

  • Lens: focuses light rays on the retina

  • Iris: muscular ring that controls the amount of light that enters through the pupil; the pigmented part of the eye

  • Pupil: hole where light rays enter the eye

  • Sclera: tough protective layer that serves as an attachment point for muscles repsonsible for eye movement

  • Anterior Chamber: space between cornea  and the lens; helps maintain the shape of the eye

  • Posterior Chamber: space between the iris and lens; helps maintain the shape of the pupil

  • Conjuctiva: thin, mucous lined membrane that covers the sclera and lines the inner eye

  • Retina: membrane on the back of the eye that receives the light rays and converts them to electrical impulses

    • ​Cones: Photoreceptor in the retina sensitive to color. High definition sight, used more in the daytime, and concentrated in the fovea centralis. 

    • Rods: Photoreceptor in the retina sensitive to black and white light. More effective in low light, and less abundant in the eye than cones. More common in the peripheral of the eye. 

  • Choroid: layers of blood vessels that surround the globe

  • Globe: what is classically called the "eyeball"

  • Optic Nerve: transmits the light signals to the brain to be processed

  • Suspensatory Ligament: attach the ciliary muscle to the lens

  • Fovea centralis: point on the retina with a high concentration of cones

  • Macula: located on the retina, responsible for detailed vision

  • "Blind Spot": spot in the eye where the optic nerve begins; no cones or rods exist in this spot, and the brain compensates by creating an image based on what the rest of the eye sees. 

 

Eye Anatomy - Other

  • Lacrimal Sac: production and drainage of tears

  • Eyelids (Upper & lower): protect the outer eye and distributes tears

  • Eyelashes: protects the outer eye from debris

  • Eyebrow: protects the eye from sweat and debris

  • Nasolacrimal Duct: carries tears from lacrimal duct to the nasal cavity for disposal

  • Superior and Inferior Canaliculus: drains tears from the eye

(http://www.harvard-wm.org/the-body-of-the-eye-model-human-model-anatomy/eye-anatomy-and-macula/) Retrieved Nov. 10 2014

(http://www.familyeyecare.com/anatomy-of-the-eye-family-eyecare-san-jose-campbell-silicon-valley.html) Retrieved Nov. 10 2014

Eye and Orbital Space

Eye Anatomy - Muscular

  • Superior Oblique: moves eye inward (medially) and downwards

  • Inferior Oblique: moves eye outward (laterally) and upwards

  • Superior Rectus: moves eye upwards 

  • Lacteral Rectus: moves eye outwards (laterally)

  • Medial Rectus: moves eye inward (medially)

  • Inferior Rectus: moves eye downwards

(http://www.ultrasoundpaedia.com/normal-eye/) Retrieved Nov 10 2014

Assessment

  • Snellen Chart Examination: Used in a clinical setting to determine visual acuity. The chart is placed on a wall with the middle of the chart at eye level, and the patient stands twenty feet away from the chart. The patient will read the first line as the clinician follows along. The patient will read each line individually until they make a mistake or they say they no longer can read the next line. This can be done with both eyes, or you can have the patient cover one eye at a time. 

    • 20/20 Vision: Emmetropia. You can read a letter from 20 feet away that a normal person can read at 20 feet. 

    • 20/40 Vision: You can read a letter from from 40 feet away that a normal person can read at 20 feet

    • The 20/20 line will be the fourth from the bottom. 

  • On-The-Field Assessment: Used to determine if damage to cranial nerves II, III, IV, and VI. Test visual acuity for CN II (Can you see the scoreboard?) and eye movement for CNIII, CNIV, and CNVI (Follow the finger). Patient can be sitting or standing for this evaluation, while the examiner should be in front of them. 

    • PEARRL: Pupils Equal, Round, Reactive to Light. Use a penlight and shine it in the patient's eye for one second. The pupil should constrict when exposed to light and expand when the light is removed, and both pupils should react in the same way. 

      • An afferent lesion to the retina or optic nerve will present as a decreased response to the light

      • An efferent lesion to cranial nerve III or the pupillary muscle lesion will present as no reaction to the light

  • Optometrist Examination: A professional examination by an optometrist should be done annually to determine the general health of the patient's eyes. Deficiencies that go undetected can result not only in athletic difficulties, but set-backs in the classroom for student athletes. An optometrist can prescribe corrective lenses for patients. Patients who are diabetic should have more frequent exams. 

  • Ophthalmoscope: A tool used for looking into the eye, giving the examiner the opportunity to look at the retina and the optic nerve. The patient should be sitting in front of the standing examiner. The patient should stare ahead and avoid blinking. The examiner will turn the ophthalmoscope's light on and shine it into the eye from three to six inches away from the eye. The examiner will look through the viewer to inspect the retina, optic disc, blood vessels, and choroid. 

    • Abnormal sights can include discoloring, spotting, engorged blood vessels, bulles, blood, or other demorities. Any deformities require immediate referal to an optometrist. 

(http://www.allaboutvision.com/eye-test/)

Retrieved Nov 10 2014

(https://www.youtube.com/watch?v=woUHtC0pqhA) Retrieved Nov 10 2014

(http://stanfordmedicine25.stanford.edu/the25/fundoscopic.html)

All images retrieved Nov 10 2014

Common Vision Disorders

  • Photophobia: intolerance to light

  • Diplopia: double vision

  • Chemosis: swelling of the conjunctiva                                 

  • Nystagmas: involuntary shaking of the eyes

  • Anisocoria: unequal pupil size

  • Myopia: nearsightedness, or inability to see clearly at a distance; eyeball is too long to focus light rays on the retina

  • Hyperopia: farsightedness, or inability to see objects nearby; eyeball is too short to focus light rays on the retina

  • Presbyopia: lens loses the ability to focus light rays, making it difficult to see things up close; often, reading glasses are needed 

  • Enophthalmos: globe is bulging medially, inferiorly, or posteriorly

  • Exophthalmos: globe is bulging anteriorly  

Orbital Hematoma - "Black Eye"

  • Bleeding around the eyes in the orbital space, also known as a black eye; caused by direct trauma.

  • Symptoms - swelling, ecchymosis, restricted eyelid movement. 

  • Diagnosis - observation by a clinician

  • Treatment - cold pack, drainage in severe situations

  • Prevention - eye protection such as goggles or a mask.

  • Athlete can participate as tolerated, but should wear eye protection until the hematoma heals. 

(https://www.facebook.com/photo.php?fbid=10202531394826900&set=a.102

02548640898041.1073741828.12565

50082&type=1&permPage=1)

Retrieved Nov 11 2014

Potential Pathologies

Conjuctivitis - "Pink Eye"

  • Infection or swelling of the conjuctiva; caused by a virus or bacteria entering eye, usually by someone rubbing or touching their eyes or putting in contacts with dirty hands. 

  • Symptoms - redness, swelling, itchiness, yellow or white discharge from the eye, crustiness 

  • Diagnosis - observation, blood tests, cultures. 

  • Treatment - antibiotic (oral or eye drops), eye patch in severe cases.  

  • Prevention - avoid touching your eyes, wash your hands prior to putting in your contacts

  • Because it is highly contagious, athlete should be withheld from activity until condition resolves. 

(http://www.medicinenet.com/image-collection/bacterial_conjunctivitis_pink_eye_picture/picture.htm)

Retrieved Nov 11 2014

Hyphema

  • Blood in the anterior chamber of the eye; caused by direct trauma, blood vessel deformity, cancer

  • Symptoms - visible blood in the anterior chamber (isolated over the iris and pupil), 

  • Diagnosis - eye examination, intraocular pressure measurement (tonometry)

  • Treatment - often, none is needed; eye patch, rest, drainage, anti-inflammatory eye drops. 

  • Prevention - eye prtoection such as goggles or a mask. 

  • Athlete should rest until all blood has cleared out of the eye. 

(http://www.aao.org/theeyeshaveit/trauma/hyphema.cfm)

Retrieved Nov 11 2014

Scleritis

  • Infection or inflammation of the sclera; caused by a bacterial or viral infection, or can be caused by autoimmune diseases such as rheumatoid arthritis. 

  • Symptoms - pain, swelling, redness, itchiness, dryness. 

  • Diagnosis - eye examination, blood tests

  • Treatment - NSAIDs, corticosteroid eye drops, treatment of underlying health problem 

  • Prevention - keeping fingers away from eyes, cleaning contacts properly

  • Athlete can participate as tolerated. 

(http://diseasespictures.com/scleritis/)

Retrieved Nov 11 2014

Orbital Fracture - "Blowout Fracture"

  • Fracture to the walls or floor of the orbital space, most often to the orbital floor; caused by a direct blow to the eye (ie. baseball, racquetball) 

  • Symptoms - pain, deformity, swelling, bleeding, ecchymosis, limitation of upward or downward gaze. 

  • Diagnosis - observation, x-rays, CT scan, MRI. AT should also check for signs of a concussion.

  • Treatment - no repair is necessary unless it severely limits eye movement; common treatments include ice, eye patch, and rest. 

  • Prevention - protective equipment such as goggles and masks. 

  • Athlete should rest until the fracture is healed, but may participate if a physician clears them. 

(http://www.aao.org/theeyeshaveit/trauma/orbital-fracture.cfm)

Retrieved Nov 11 2014

Corneal Abrasion

  • Traumatic erosion of the corneal surface; caused by foreign bodies entering the eye and scratching it, by fingers rubbing the eye, or by direct trauma. 

  • Symptoms - pain, redness, itchiness, burning, impaired vision, feeling of something stuck in the eye. 

  • Diagnosis - ophthalamology exam, fluorescent strips/eye drops, history. If patient doesn't use contacts or have a history of trauma, be suspective of a surface infection. 

  • Treatment - eye patch, antibiotics, steroid eye drops, NSAIDs.

  • Prevention - protective equipment such as goggles and masks, proper cleaning of contact lenses. 

  • Athlete should rest until the abrasion is healed to prevent further damage to the cornea, but may participate if a physician clears them. 

(http://www.aao.org/theeyeshaveit/trauma/corneal-abrasion.cfm)

Retrieved Nov 11 2014

Ruptured Globe

  • The integrity of the outer membranes of the eye is disrupted by blunt or penetrating trauma. 

  • Symptoms -  pain, loss of vision, elliptical or teardropshaped, black spots on sclera, chemosis, deformed globe, lens, or iris, hyphema.

  • Diagnosis - observation, CT scan

  • Treatment - This condition is considered a medical emergency. The eye should be covered, any foreign bodies in the eye stabilized, and the patient should be transported to the emergency room for treatment. Emergency surgery will be performed as soon as possible. 

  • Prevention - protective equipment such as goggles and masks. 

  • Athlete should not participate until cleared by a physician. 

(http://emedicine.medscape.com/article/798223-overview/)

Retrieved Nov 11 2014

Stye

  • Infected or inflammed sebaceous gland at the base of the eyelashes, caused by a bacterial infection introduced by dirty contacts, make-up, or fingers rubbing the eye. 

  • Symptoms - redness, pus-filled papule, tenderness, painful blinking

  • Diagnosis - physical examination

  • Treatment - warm compress, cleansing; this condition usually resolves itself. 

  • Prevention - keeping fingers away from eyes, cleaning contacts properly, removing make-up

  • Athlete can participate as tolerated. 

(http://byebyedoctor.com/stye-eye-

symptoms-causes-pictures-treatment-prevention/)

Retrieved Nov 11 2014

Detached Retina

  • A separation of the retina from its supporting layers, as the connective tissue pries the retina away from the back of they eye; cause by diabetes, eye disease, jarring force to the head, severe sneeze

  • Symptoms - blurry vision, 'floaters', flashing lights

  • Diagnosis - ophthalamology examination by a specialist (referral)

  • Treatment - referral, immediate surgery necessary to prevent blindess. 

  • Prevention - regular eye exams.

  • Athlete should rest until the condition resolves itself. 

(http://www.retinala.com/retinal-detachment.html)

Retrieved Nov 11 2014

Embedded Foreign Body

  • A foreign body becomes embedded in the eye. 

  • Symptoms - pain, swelling, redness, itchiness, tearing, visible object in eye.

  • Diagnosis - eye examination

  • Treatment - Cover the eye (eye patch, plastic cup securing the object) and transport to the hospital.

  • Prevention - wearing protective eye equipment such as goggles or a mask. 

  • Athlete shouldn't participate until the foreign body is removed. 

(http://www.fpnotebook.com/legacy/Eye/Trauma/CrnlFrgnBdy.htm)

Retrieved Nov 11 2014

(Starkey 2010) 

(Maanika 2013)

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