The IH needs a trained mind and eye.
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Eye injuries caused by ski stick handles are rare but serious. The material and shape of the handle can be designed to prevent serious injury without adversely affecting function. Even at winter temperatures polyurethane remains moderately malleable and shock-absorbent; it is light, and is a poor heat conductor, so that the hands do not get cold quickly. The end of the handle is 8 cm in diameter; attached to this is an adjustable loop which fits around the hand. The loop opens on impact. It is thus impossible for the orbit to sustain injury and there is less danger to other injury-prone regions of the body such as the neck and stomach. The anatomically designed handles, with wide thumb supports, help prevent hand injuries, and in particular thumb injuries, to a large extent. Such injuries have occurred frequently in the past.
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Ice hockey is a fast-paced game involving both finesse and controlled aggression. Injuries are related to direct trauma (80%) and overuse (20%), with high puck velocities, aggressive stick use, and body checking (collisions) accounting for most of these. A participant can anticipate an injury after playing 7 to 100 hours of hockey, depending on his age, and most injuries are caused during the actual game rather than during practice. Although facial injuries are common, they are decreasing because of adequate use of helmets and masks. Conversely, cervical spine injuries are being reported more frequently. Injuries to the upper extremity include acromioclavicular joint dislocations, scaphoid fractures, and 'gamekeeper's thumb.' Injuries to the lower extremity predominantly involve soft tissue, with strains of the hip adductor, tears of the medial collateral ligament of the knee, and contusions of the thigh are common. Scientific studies have reduced injury by providing improved protective equipment, stricter rules and their enforcement, and effective training and conditioning.
An evaluation of the "chemical trapping premise" was made to determine if, in fact, chemicals do accumulate behind a contact lens if a wearer encounters chemical splash. Photographs were taken to document the effect of chemical splashes. A photograph of a normal eye, Fig 7, taken prior to the insertion of a contact lens is included for purposes of comparison. Under the conditions investigated, it was demonstrated that, for liquid irritant exposures, eyes are afforded more protection when wearing contact lenses than when not. Test results suggest the contact lens acts as a barrier to the irritant on the cornea. The investigators postulate that lid spasm occurs, causing the lens to tighten against the cornea, thereby effectively sealing off the area under the lens. Since the "barrier" effect appears to be a function of time, more testing of this variable is warranted. Moreover, further investigation is indicated using a broader spectrum of irritants and an extended environmental exposure to dust and vapors.
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One hundred and seventeen children aged 0-17 years treated for eye injuries at the Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria were studied. Seventy-five were males and 42 were females with a mean age of 10 years 4 months. Injuries occurred with increasing frequency after the age of 4 years and were commonly sustained by children at play (50.4%); during corporal punishment (10.3%); assault (9.4%) and street hawking (9.4%). Causative agents were mostly sticks and twigs, followed by missiles and fall. Visual prognosis was best in patients with contusion injuries (48.3%) and worst in those with perforating eye injuries (30.5%). Blindness of the injured eye occurred in one-third of the patients and another 17.5% had significant visual impairment. This study shows a variation in the aetiology and visual outcome of eye injuries in the young. Strategies for the prevention of eye injuries are mainly health education, improved supervision of children at play, change in the method of corporal punishment and provision of protective devices for adolescents at work. Early diagnosis and prompt management will improve visual prognosis.
PURPOSE: The aim of this study was to highlight the neuro-ophthalmological dangers associated with horse riding, and working around horses, and the importance of wearing adequate headgear to protect the rider from neuro-ophthalmic injuries. It raises the questions of whether the current laws regarding helmet use are satisfactory, and whether helmets currently used are of an adequate standard. METHODS: The records over a 20-year period of one neuro-ophthalmologist in Adelaide were reviewed producing 22 patients with neuro-ophthalmological sequelae of head injuries as a result of horse-related accidents. RESULTS: There were 22 patients (16 female, six male), one of whom was involved in three separate accidents, Of these, seven were professional riders and 15 amateur. In 20 of the 24 accidents, patients were either thrown or fell from the horse. Helmets were worn in 15 of the accidents. All the patients had closed head injuries of varying severity. The most common neuro-ophthalmological complication found was a fourth-nerve palsy in 11 patients. Five patients had a significant loss of vision and two of these were severe enough to warrant a blind pension. CONCLUSIONS: Horse riding and working around horses constitute an occupation or recreation with inherent dangers. Previous studies have shown that wearing of protective headgear reduces the risk and severity of head injuries, and helmet use should be vigorously promoted. The current laws and practices regarding helmet use are not uniform and seem to be inadequate. The current standard for equestrian safety helmets (AS/NZS 3838:1998) embodies improvements on earlier helmet standards and certainly increases the rider's chances of surviving a severe impact. Nevertheless, serious brain injuries have occurred in wearers of approved helmets, and further research is desirable to ensure the optimum degree of protection compatible with rider acceptance.
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