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Introduction

Resulting from a direct blow, impalement, or chemical invasion, trauma to the eye requires an accurate assessment so that proper management and further evaluation by an ophthalmologist can be initiated. Failure to recognize and properly manage eye trauma can result in permanent dysfunction, including blindness.

Racquet sports (in which the ball can reach speeds up to 140 mph), boxing, and golf are most often associated with catastrophic injury to the eye. However, traumatic injury to the eye can occur in all sports, with basketball being the most common.1,2 An estimated 90% of all eye injuries can be prevented through the use of approved protective eye wear.

Clinical Anatomy

The eye, except for its anterior aspect, sits encased within the conical bony orbit (Fig. 18-1). In addition to protecting and stabilizing the eye, the orbit also serves as an attachment site for some of the extrinsic muscles acting on the eye. The orbital margin (periorbital region) is composed of the frontal bone, forming the supraorbital margin; the zygomatic bone and a portion of the frontal bone, forming the lateral margin; and the zygomatic bone and maxillary bone, forming the infraorbital margin.

FIGURE 18-1

Bony anatomy of the orbit and orbital rim (periorbital region).

The anterior portion of the orbit's roof is formed by the frontal bone. A portion of the sphenoid bone forms its posterior aspect. Medially, the orbit is formed by the thin lacrimal, ethmoid, maxillary, and sphenoid bones. The floor is formed by the maxillary, zygomatic, and palatine bones. Laterally, the orbit is composed of the zygomatic bone and the sphenoid bone. Here the orbit is the thickest. The superior orbital fissure, an opening between the lesser and greater wings of the sphenoid bone, is located between the lateral wall and the roof. This fissure allows the cranial nerves, arteries, and veins to communicate with the eye. The orbit's posterior aspect is marked by the optic canal, the foramen through which the optic nerve passes to reach the brain.

Eye Structures

The mass of the eye is a fibrous, fluid-filled structure collectively referred to as the globe. Its white layering, the sclera, encompasses the posterior five-sixths of the globe and becomes continuous with the sheath of the optic nerve as the nerve continues posteriorly and merges with the brain's fibrous lining. The dark central aperture of the eye, the pupil, is surrounded by pigmented contractile tissue, the iris (Fig. 18-2). The conjunctiva, a thin mucous membrane, covers the sclera and lines the inside of the eyelids. Anteriorly, the conjunctiva is continuous with the transparent cornea. The cornea is the main structure involved in focusing light ...

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