Eye injuries: From “No big deal” to “HOLY S*%T” Part 1

Pardon the extended absence – med school is a complete timehog.  Having just taken my final exam in psychiatry (and subsequently diagnosing everyone I know with personality disorders), I finally have time to sit down and bring you some nasty pictures of injured eyes.

Eye injuries go with hockey like mullets and missing teeth.  In this series I’ll be explaining the various injuries that can happen, and how they’re diagnosed and treated.  I’ll be going from least gross to most obscene, and as such we’ll be starting with injuries to the surface of the eye.

Corneal Abrasion

One of the least exciting types of eye injury is the corneal abrasion – a scratch on the surface of the eye.  Unless of course you’ve ever had one, in which case you know that it feels like there’s an entire tree branch lodged in there.  Corneal abrasions can be of varying severity, but generally speaking they’ll heal in a couple of days with minimal intervention.  This is the most common eye injury doctors see.

Corneal abrasions cause eye pain, a foreign body sensation (fancy talk for “it feels like there’s something in my eye”), redness, and a watery eye.  The diagnosis is made by putting fluorescent eye drops in the eye and examining it through a special lens (a slit lamp).  The drops (fluorescein) will fill the abrasion and make it glow.

Corneal abrasion after fluorescein drops

Corneal abrasions are generally treated with anesthetic drops before the slit-lamp exam, then antibiotic drops or ointment are prescribed for the healing period.  If the pain is particularly bad, there are NSAID eye drops (like Advil for your eye) or regular oral pain medications if needed.  There’s some debate as to the value of patching the affected eye.

Corneal abrasions are common from misuse of contact lenses, but in the context of hockey this is the sort of thing you might end up with if someone’s stick, hand, or a puck found its way into your eye.  The average abrasion will feel better in about 48 hours, but it can be as long as 6 weeks before the surface of the eye returns to its pre-injury state, so it makes sense to protect your eyes after something like this.

Corneal abrasions can be deep enough to cause an ulcer in the surface of the eye, and infection can grossly complicate the healing period.  A deep abrasion, or one that healed poorly, can scar and leave lasting vision deficits.  Proper management of an injury like this is the key to successful healing and no complications.

Subconjunctival Hemorrhage

Trauma to the eye can also result in one of the more impressive-looking and yet least medically impressive injuries – subconjunctival hemorrhage.  The conjunctiva is the white of your eye, and a subconjunctival hemorrhage is exactly what you’d think – bleeding underneath the white of the eye.  This is usually spontaneous, but obviously can also be caused by trauma.  There are normally no symptoms of pain or actual bleeding from the eye, but it looks extremely badass.

Subconjunctival Hemorrhage

This will generally heal on its own in less than two weeks (hence medically unexciting).

And here’s Steve Yzerman showing us what happens when you take a puck in the face and end up with a corneal abrasion, subconjunctival hemorrhage, and a fractured orbital bone (that’s the one your eyeball actually sits in) which required surgery.

Yzerman: So badass he gets all the eye injuries at once.

Yzerman played with a visor post-injury, and now as Tampa Bay Lightning GM he’ll be asking his players to wear them next season.  Vinny Lecavalier took a stick in the eye at the beginning of this month resulting in a corneal abrasion, and put it best with his comment to the St. Petersburg Times on visor use in the NHL:

“If I never took it off, I’d be fine with it.  But once you take it off and you see perfect, when you put it back on, you feel a little restricted. It fogs up. The right thing to do would be to come from junior and never take it off.”

– Vincent Lecavalier

Is the suggestion that visors should be grandfathered in, much like helmets were in the 90s?  Nobody complains about having to wear helmets now – it’s an accepted part of playing hockey.  My hope (and the hope of ophthalmologists everywhere) is that visors will follow the same path.  15 years from now this should be a non-issue.

Next time: Our parade of eye grossness takes a step forward with blunt eye injuries.  We’ll talk about what happens when your eye gets squished, and just how much blood you can fit inside an eye.

– J0