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Microsoft word - eyeinjuriesinboxing.doc
EYE INJURIES IN BOXING
The era of blindness as a result of boxing is past.
However boxing doctors have become more aware of ocular damage: retinal detachment being the most frequently observed serious injury in professional boxing.
Ocular injuries as a result of boxing mainly affects professional
The eye is relatively well protected by the orbit except at the front.
The ocular damage is caused by direct blunt trauma or sometimes by indirect shock.
Conjunctiva Cornea Anterior chamber Iris –corneal angle Iris Lens
In reference to the cerebral injuries three mechanisms explain the ocular damage :
Transmitted force = ‘’contrecoup’’
Anterior compression and equatorial expansion with the following effects :
o for the orbit and its content : stretching and shortening of each component
o antero posterior shift of the eyeball brings about high pressure in the orbit
OCULAR CONCUSSION INJURIES
- wound - oedema or swelling - haematoma
- fracture (floor ++) - underplaced fracture ??? Sorry I do not know what this is ??displaced
changes in the pupil and accomodation ++ traumatic miosis and accomodation spasm traumatic iridoplegia and cycloplegia tears at the pupil border iridodialysis recession of the angle +
subepithelial subcapsular traumatic zonular cataract diffuse concussion cataract total cataract subluxation, luxation
concussion edema hemorrhage laceration rupture detachment
oedematous and atrophic changes concussion oedema
macular (Berlin oedema)
peripheral atrophic changes retinal detachment
All those lesions are described in literature and may be theoretically
cornea laceration by glove abraision : 2 particular accidents
post traumatic diplopia following an hematoma on the inside of the orbit or a muscular
lid emphysema, in the case of a fracture, the air of the sinus penetrates into the orbit.
Remark: repeated lesions of the brow may train a healing granuloma which is best excised to prevent recurrences
clinical sign = fall of vision diagnosis = lens opacity treatment = intra ocular lens (IOL) result is excellent but unfitness to box
usually secondary to pre-existent lesions, sometimes caused by an unique shock.
Mechanism = a retinal detachment occurs for two reasons: either there is a
tear or because there is an abnormal traction on retina
clinical signs = immediately or not, black spots, flashes
treatment = endo-ocular surgery completed or not, by laser photo coagulation
Prevention must be the first treatment
Statistics, studies summary:
No report in medical literature describing ocular injuries prior1980.
10 retinal detachments over the preceding 35 years
74 boxers, asymptomatic and theoretically chosen in sequential fashion (every 7th boxer)
ranging from cutaneous scarring to retinal detachment’’
1987 : sponsored by the New York State Athletic Commission (NYSAC)
154 boxers examined by 20 ophtalmologists
286 boxers, 22 ophthalmologists
1989/1999 : Medical Commission of French Boxing Federation :
8000 boxers, every, year during 10 years (annually ocular examination is obligatory)
23 boxers unfit to box for ocular problems : only in professional boxing
successfully (100%) operated detachment = 13
The 1989 study concerns boxers examined for ocular problems. It was flawed as one
ophthalmologist who examined only 8% of the boxer discovered 95% angle recession!! (that amount of vision threatened is rare in boxing).
Different types of cataract must be distinguished : minimal, subcapsular, anterior
posterior, corticalor total. Supervision is required to avoid dangerous development
OCULAR SAFETY IN BOXING
For a number of years ocular safety has been a concern for the IABA Medical Commission.
An annual examination is recommended
- to maintain a reasonable limit for boxing - to check the state of the eye - to detect pre existing lesions around the retina - to decide preventive treatment (laser photo coagulation)
Ocular requirements for licensure by
INTERNATIONAL ASSOCIATION of AMATEUR BOXING
Uncorrected visual acuity:
No intra ocular surgery (cataract, retinal detachment)
Absence of ‘’major ocular pathology’’ (glaucoma, macular abnormalities, major lens
abnormality, dangerous peripheral retinal lesions).
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E/M Levels 2, 3 and 4 Established Patient Visits A Distinction with a Difference Statistically, the overwhelming majority of patient officeUnless symptoms persist, the patient is to return to thevisits are billed at E/M Levels 2, 3 or 4. Determiningoffice in two weeks for follow-up. The patient’s which billing level is correct for a particular patientneurologist, Dr. Banks, will be ad