These AHL callup rules are so stupid. I don't know why the PA would want a rule that limits a player's ability to be called up to the NHL and make a better salary. Apparently they are more concerned with whether their veterans can get off the bench.
It has to do with the AHL teams being able to field competitive teams late in the season and in their play-offs.
Fans support the AHL team all year and it is not fair to simply allow a team to have their best players air-lifted out because the NHL roster limits have disappeared. Once the season is complete for an AHL team, then the NHL team can call-up as many players as they want (assuming there is cap room in the regular season).
These are completely different. For comparison, it's the difference between a scratch on the skin of your arm versus a stab wound or crush injury.
It is possible surgery was done to repair an eyelid laceration, but I personally doubt an eyelid lac is the only thing going on with all the concern over his vision. Like I wrote in my first post, a bedside procedure to relieve pressure from a retrobulbar hemorrhage is also possible, but again, I doubt this based on the natural history and recovery from this type of injury.
Like I wrote in another reply, there is no such thing as being unable to examine the eye because of eyelid swelling. The only reasons would be lack of the correct instrument (which is unlikely in a major trauma center) or lazy ophthalmologist. I hope for Malhora's sake it isn't either of these.
This description means nothing coming from a reporter. To most people, swollen eye really means swollen eyelid and doesn't say anything about the condition of the eye itself. Blood around the eye could be anything from subconjunctival hemorrhage (scary looking but not dangerous in itself, like the picture of the player posted by VanEric), periocular bruising of the skin, or blood in the orbit. You only ask about what you know, and in my experience the vast majority of people have no idea what a ruptured globe injury is. For some reason, everyone always wants to know if it's a detached retina or orbital bone fracture.
I'd be shocked if Malhotra's ophthalmologists don't know exactly what is going on with the eye. I'd expect he is being treated at UBC, where there are prominent ophthalmologists who are highly respected in the field, so he will be in good care. Lack of communication, not diagnosis, is probably the problem here. Prognosis, on the other hand, is going to be up in the air until more time has passed.
Ah, thank you. So based on the distinction between a cornea laceration and scratched cornea I have a reasoned follow up question. You had localized a diagnosis to three possibilities, based on the information we had available. They were as follows:
Originally Posted by KHB
There are only a few possible reasons he would have needed surgery immediately. You may want to refer to this image of the anatomy of the eye while reading:
(1) Malhotra may have had a retrobulbar hemorrhage (bleeding into the eye socket) which put very high pressure on the eye and optic nerve and put him at risk for permanent blindness. This procedure would have been a lateral canthotomy and cantholysis, where the tendons of the eyelids near the temple are cut to allow the eye to protrude forward form the eye socket and relieve the pressure. This is a minor procedure which is done at the bedside in the emergency room, but I would not be surprised if people mistakenly called it "surgery." Delaying the procedure to coordinate a trip to the OR is not standard of care, as the rapidly elevating eye pressure must be relieved as soon as possible. I think this is unlikely.
(2) Malhotra may have had a vision-threatening orbital canal fracture. If the bones around the portion of the optic nerve connecting the eye to the brain are broken, they may press upon the optic nerve and cause permanent damage, leading to blindness. Surgical decompression of the orbital canal may be indicated to remove the bone fragments pressing on the optic nerve. High dose systemic IV steroids can be part of the treatment to reduce swelling in the area and emergent decompression is very rare. It also a subspecialist (orbital surgeon, neurosurgeon, or maxillofacial surgeon). I think this is even more unlikely.
(3) Malhotra may have suffered a ruptured globe injury, where the eye wall (sclera or cornea) sustained a laceration due to direct impact by the puck. Repair of this injury is a major ophthalmic surgical procedure which is typically done within hours of presentation. It is one of the true ophthalmic surgical emergencies. The patient is taken to the operating room, general anesthesia is given, and the eye is sewn back together with sutures as best as possible. Based on the mechanism and photos of the injury, and on reports of how the vision is severely affected, I suspect that the injury is a ruptured globe.
When the eye is struck with a blunt object like a hockey puck at high velocity, there can also be be tremendous bleeding into the eye itself, which make it difficult to assess the extent of damage to the internal structures of the eye, such as the lens and the retina. These lead to questions about the visual potential in the eye and inability to provide an accurate prognosis. In general, the prognosis is very guarded. I always tell patients that the main goal is to save the eye so that it does not need to be removed. A distance second goal is to rehabilitate the vision. The patient may need multiple surgeries after the initial surgery to repair other damaged structures inside the eye. Having to consult with multiple ophthalmologic subspecialists within a few days after the surgery is typical to determine what other work needs to be done. There are life-long implications with this type of injury and vision may never return to normal. A small percentage of patients do lose the eye completely to completely loss of light perception with extreme pain, glaucoma, unrepairable retinal detachment, uncontrolled inflammation, or infection.
Let's also discuss what this is probably not and dispel some misinformation.
It is probably not "just" an orbital fracture. Orbital fractures are not fixed emergently, even for a high profile athlete, save for the rare case I outlined above where there's potential optic nerve impingement. Even in that case, surgery within hours of the injury isn't likely.
It is probably not "just" a retinal detatchment. Yes, he may have a detached retina underneath it all, but surgery to fix a traumatic retinal detachment if there is no other eye injury is not done emergently overnight. It requires a subspecialist eye surgeon (vitreo-retinal surgeon) and could require sophisticated equipment that needs to be run by special trained operating room technicians. Mobilizing all of that in the matter of hours usually doesn't happen, and retinal detachment surgeries usually go to the OR during the daytime when it can be all organized.
It is probably not "just" bleeding into the eye without a ruptured globe. Hyphema, or bleeding into the front portion (anterior chamber) of the eye, is common with blunt trauma, but emergent surgical evacuation of the blood is not indicated. Although the eye pressure may get very high, topical and oral medications are given at first, and surgery is only considered days later if the eye pressure is extremely elevated in the presence of non-clearing blood. Vitreous hemorrhage (bleeding into the main cavity of the eye) is not surgically removed if there is no other structural eye problem until weeks to months have passed. It also requires a vitreo-retinal specialist and special equipment to do a vitrectomy surgery, which is done as a scheduled, non-emergent procedure.
In my opinion, if the eye injury was severe enough to need surgery, Malhotra's playing days should be over. It's not worth the risk of blindness if there is injury to the healthy eye. I know there have been multiple athletes who have returned to play after a severe eye injury, but it's just plain foolish in my mind to play Russian roulette with your vision.
I hope this has been helpful to some people out there.
Based on the three major categories you had outlined, is it possible that a scratched cornea (with Hyphema) could be a result that falls within the extremes of a 1) Retrobulbar Hemmorhage and 2) Orbital Canal Fracture? Just like a ruptured globe (due to cornea laceration) falls within the two extremes?
If this is the case, then the reports of surgery and excessive bleeding around the eye could be due to a scratched cornea, which carries with it far less dire implications than that of the ruptured globe diagnosis everyone is dreading.
hope he gets well soon and recover 100% vision. That said this isn't exactly the worst case for the Canucks, Hodgson might not fit very well for the fourth line center, but he might do just fine on the third line with better players like Torres and Hansen. Torres had a great shoot and it could play well with Hodgson playmaking skill.