Medical Issues in American Football – Author
September 7, 2016 | Other | 
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Medical Issues in American Football: Eyes, Teeth, and Skin
Bruce J. Thomas II, MD. Garry W. K. Ho, MD, FACSM, FAAFF,Timothy J.Yu, MD, and Michelle I. Henne, MD
Abstract
Providing care to football players often in-volves recognizing and treating nonorthopedic conditions. We report on common ophthal-mologic, dental, and derrnatologic conditions seen by the football team physician.
Eye Injuries
More than 2.5 milfca eye injuries occur each year, with 50,000 people permanently losing part or al of their vision.1 Eye injuries account for over 600,000 yearly emergency department visits; over 30% of these eye injuries were attributed to a sports injury.1 Football is classified as high risk for eye injury, along with baseball, hockey, basketball, and lacrosse.2 Common eye injury mechanisms are categorized as blunt, penetrating, and radiating. Blunt injuries are most common.2 When evaluating an athlete on the sideline, relevant history would include the size of the object, the level of force, and the direction from Which the impact occurred. An examination should indude best-corrected visual acuity using an eye chart, confrontational visual fields, assessment of extraocular movements, assessment of red reflex, and pupil evaluation with a light source.2
Comae Injuries
The outermost layer of the eye, the cornea, can be subject to blunt and penetrating injuries. Corneal abrasions often occur from mechanical trauma, such as one from the fingernail of an opposing player, that disrupts the integrity of the corneal epithelium. A corneal abrasion can be identified by applying fluorescein strips after application of a topical anesthetic. Abrasions appear fluorescent green when viewed with a cobalt blue light. If an abrasion is identified, management includes preventing infection and treating pain. Prophylactic topical antibiotics can be applied, particularly for contact lens wearers. Patching has not shown benefit in treatment of pain.3 The physician can consider using topical nonsteroidal anti-inflamma-tory drugs, such as diclofenac or ketorolac, with a soft contact lens to treat the pain.4 The patient should follow up frequently for monitoring for infection and healing.
Orbital Factures
Orbital fractures should be considered when an object larger than the orbital opening, such as an elbow or knee, causes blunt trauma to the sur-rounding bony structures, or a digital poke occurs to the globe.5 The floor of the orbit and medial wall are thin bones that often break sacrificially to pro-tect the globe from rupture. Examination findings may include diplopia, sunken globe, numbness in the distribution of infraorbital nerve, or periorbital emphysema.6 Urgent evaluation should be con-sidered to rule out associated intraocular damage. Imaging and a physical examination can help guide surgical management, if indicated. The most common outcome after this injury is diplopia with upper field gaze.6
Retina Issues
Trauma to the face or head may result in a sepa-ration of the retina from the underlying retinal pig-ment epithelium and allow vitreous fluid to seep in and further separate the layers, causing a retinal
Authors’ Disclosure Statement: The authors report no actual or potential conflict of Interest in relation to this article.
September/October 2016 The Ainerkan Journal of Orthopedics
