Chapter 136

### Introduction

Exercise and temperance can preserve something of our early strength even in old age.

Cicero (106–43 BC)

Although there is considerable overlap between injuries occurring during everyday activities and those of sporting and recreational activities, many injuries are characteristic to sportspeople. A large proportion of these injuries are the result of trauma of various degrees and include the many varieties of fractures, dislocations and soft-tissue injuries.

On the other hand ‘runner’s anaemia’—an iron deficiency—is considered to be multifactorial, including mild haemolysis and blood loss from the bladder, kidney and gastrointestinal tract (see CHAPTER 76).

#### INJURIES TO THE EYE

Blunt injuries to the eye are common in sport. Examples include tennis and squash balls, cricket balls and baseballs, and fists and fingers associated with body contact sports. Haemorrhage is the most common problem and occurs throughout the eye: subconjunctivally, in the anterior chamber (hyphaema), into the vitreous, and underneath the retina or choroid.

Another common problem is a corneal abrasion, where a small wound can be caused by a foreign body, a fingernail or a contact lens. It needs to be treated with great respect (see CHAPTER 51).

##### Hyphaema

With hyphaema, bleeding from the iris collects in the anterior chamber of the eye (see FIG. 136.1). The danger is that, with exertion, a secondary bleed from the ruptured vessel could fill the anterior chamber with blood, blocking the escape of aqueous humour and causing a severe secondary glaucoma. Loss of the eye can occur with a severe haemorrhage. It is likely to happen between the second and fourth day after the injury.

###### FIGURE 136.1

Hyphaema of the eye showing blood in the anterior chamber; this occurred in a 29-year-old man who was struck in the eye by a squash ball

Management

• First, exclude a penetrating injury.

• Avoid unnecessary movement: vibration will aggravate bleeding. (For this reason, do not use a helicopter if evacuation is necessary.)

• Avoid smoking and alcohol.

• Do not give aspirin (can induce bleeding).

• Prescribe complete bed rest for 5 days and review the patient daily.

• Apply padding over the injured eye for 4 days.

• Beware of ‘floaters’, ‘flashes’ and field defects.

Arrange ophthalmic consultation after 1 month to exclude glaucoma and retinal detachment. No sport before this time.

Generally, recovery runs an uneventful course. If secondary bleeding occurs (usually the second, third or fourth day) the patient should be transported immediately to the nearest eye hospital. Evacuate by air (not by helicopter) only if the cabin altitude can be kept below 1300 metres (4000 feet). It is important to prevent vomiting and expansion of air within the eye.

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