Ophthalmology

Sports and Eye Injury Prevention: Frequently Asked Questions

Al Aly, M.D.
Division of Plastic Surgery
University of Iowa Hospitals and Clinics

Creation Date: May 2000
Last Revision Date: May 2000
Peer Review Status: Internally Peer Reviewed

What types of sports do you find yield the most eye injuries?

It depends on the age of the participant. Baseball has the most eye related injuries in the U.S. This is especially true for children under age 12. In the age 15 to 24, basketball results in the most injuries. The most severe injuries used to occur in hockey, but the addition of strict eye protection requirements has significantly reduced ocular related eye injuries.

What type of protection do you recommend?

That depends on the type of sport one is playing. The American Academy of Ophthalmology has specific recommendations for appropriate eye protection for different sports. For example, a sport such as soccer is adequately protected with sports goggles that have polycarbonate lenses. Football requires a polycarbonate shield on the helmet. For some sports such as wrestling, no eye protection is available.

What should be done at the time of injury to take precautions before a medical professional arrives or is seen?

The first thing to do is to cover the eye for protection. This could be done with a metal shield or any rigid structure that could be taped over the eye. Sometimes, if nothing else is available, a Styrofoam cup can be taped over the eye such that it fits snugly around the bones of the eye. If the injury was such that the eye had been ruptured, even minor pressure on the globe could result in irreparable damage.

What type of injury is most common to the eye during sports?

Fortunately, the most common injury would be a corneal abrasion. This injury, although quite painful, usually heals with no permanent damage. However, more serious injuries can occur such as blood in the eye (hyphema), cataract, glaucoma, or retinal detachment.

When blood vessels are broke in the eye, how long does it take for them to clear up?

That is quite variable. It is very similar to a bruise. A small amount of blood can clear within hours to a day but a large amount of blood may never clear. In these cases, surgery is required to remove the blood.

Is it dangerous to play sports after a lasik procedure? How much time is needed after procedure to play basketball for instance?

Lasik weakens the cornea and thus would increase the chance of damage to the cornea with severe trauma. However, generally speaking, there are other areas in the eye that would rupture at the time of trauma before the cornea and thus Lasik procedure is generally felt to be safe, for people in sports. Nevertheless, eyewear protection that is appropriate to the sport still needs to be worn.

How many injuries require surgery?

Of sports related injuries, less than 10 percent would require surgery. This number is quite variable however depending on the sport. For example, squash injuries are more likely to be mild and not require surgery than are paintball injuries or ice hockey injuries.

Do many eye injuries lead to blindness?

In sports injuries, approximately 90 percent of injuries can be prevented by protective eyewear. Blinding injuries occur in over 41,000 cases of sports related injuries a year.

What is a lasik procedure?

A lasik procedure is a surgery to correct nearsightedness. Part of the cornea is surgically removed and the cornea is reshaped to eliminate the need for glasses for nearsighted patients.

Is it safe to wear hard contacts while playing sports?

Yes it is, as long as appropriate eye protectors are being worn for that specific sport.

What is the most common eye injury found in squash, now that you mention it?

Fortunately, it again is corneal abrasion. More severe injuries from squash are much less common.

Is there such thing as temporary blindness?

Yes there is. Many problems, such as hemorrhaging in the eye, can lead to temporary blindness.

Why is eye protection during sports participation so important?

Because 90 percent or more of sports related appropriate eye protectors could prevent eye injuries.

Is any research being done on this topic?

Yes definitely. The U.S. Eye Injury Registry was formed in the early 1990s to try to provide epidemialogic data regarding eye trauma. However, at this time, only about 3 cents of every eye research dollar is spent on eye trauma. Since eye trauma is estimated to be the most preventable cause of blindness in young America, it is my opinion that more research dollars should be spent on this topic.

What are some of the risks involved with eye surgery?

That varies quite a bit depending on what surgery is being performed. As with most surgeries, bleeding and infection are possible and can cause permanent loss of all sight. Fortunately, these are rare complications in most surgeries.

In temporary blindness, how long does it take to recover sight?

It is quite variable and depends upon the reason for temporary blindness. It can last from hours to months.

What is a detached cornea?

There actually is no such thing as a detached cornea. The most common injury to the cornea is an abrasion, but the cornea can also sustain partial thickness or full thickness laceration.

Are eye injuries as common in sports as orthopedic injuries?

The type of injury depends on the sport. For example, orthopedic injuries are more common in wrestling than eye injuries. In some sports such as golf, eye injuries are quite rare. However, the injuries in golf usually result in loss of all useful vision. This is due to the high velocity and size of the golf ball and golf club.

Why do you think people don't protect their eyes?

There are many reasons for this. Probably the most common reason is its inconvenience. If someone does not already wear glasses, it is inconvenient for them to put a pair on. At least they feel this way until they get an eye injury. Often times, a severe eye injury will change this opinion. We strongly recommend that people who have had severe injury to one of their eyes wear protective eyewear at all times. It is still possible to safely participate in most sports if you have only one good eye. However, some sports have no adequate eye protection. For example, boxing and full contact martial arts have no adequate eye protection available. It is best for functionally one-eyed people to avoid these sports in my opinion.

Do you tell people to stay away from sports after having an injury?

Until their injury is healed, it is best to refrain from certain strenuous activities. Your eye care practitioner should be able to give you advice as to which activities are appropriate. Most people can safely return to sports following an eye injury if they use appropriate eye protection specific for their sport.

Did you see the injury the hockey player suffered a few weeks ago? Wow! What was that type? I think he is blinded in that eye.

I have not heard all the details about this injury, but I am pretty sure that his eye was ruptured. This means his eye was "split open" and that some of the internal contents came out. This kind of injury has a very poor prognosis.

How long does it take to heal?

It is variable, but for ruptured globes, there is usually massive, permanent damage.

Do you think they should require face shields?

In my opinion, yes. Face shields, when used in the Canadian youth leagues, decreased significant eye injuries to a very small level. It has been very difficult, however, to get the older hockey players to wear such protection. Some hockey players object that shields restrict their peripheral vision. They feel that it decreases their performance. Obviously, severe loss of vision severely affects your performance as well. We always have to make tradeoffs in the world.

Is the eye a very durable muscle? That is, can it take a lot of abuse?

The eye is actually not a muscle. The eye is very similar to a camera in that it has a lens that focuses light on a piece of "film". This film is called the retina. Information that is focused on the retina is then transmitted down the nerve, called the optic nerve, and arrives at the brain. The white part of the eye is called the sclera. It is a tough durable layer, but it is relatively weak in the region where it attaches to the cornea in the front of the eye and where it attaches to the optic nerve in the back. These are two areas of the sclera that are susceptible to rupture during eye trauma. There are some people whose sclera is much thinner than others in these people minimal trauma to the eye can cause rupture to the sclera.

What type of surgery do you most often perform, and who is your typical patient?

In my practice, the most typical surgery I perform is called the vitrectomy. This surgery involves removing the vitreous jelly from the center of the eye. Frequently in people with severe diabetic changes in the eye, the vitreous can become very cloudy due to hemorrhaging. Sometimes a remove of the hemorrhage is required to restore useful vision. Minimal amounts of hemorrhage can sometimes settle to the bottom of the eye and clear without surgical intervention.

Are there any eye injuries that are hopeless, meaning, no treatment available?

Generally speaking, many injuries that have been severe enough to result in loss of the ability to see even brightest light are "hopeless." There are, however, some eyes that only transiently lose the ability to see light. It is very important to have a trained eye practitioner examine patients to make this determination.

What do you consider the most dangerous sport, for eyes?

Some people consider war the ultimate sport. Wartime injuries to the eye have increased with each war. Fortunately, military has eye protection programs underway. If you exclude war, probably the most dangerous sport currently being played is paintball. The gelatin coated pellets shot from air guns during war games travel at 300 feet per second and can easily rupture the eye when fired from distances of 12 feet or less. BB guns and air rifles also are extremely risky "sports" for the eye.

What do you think is important for us to know, as athletes, about protecting our eyes?

I think the most important take home message is the greater than 90 percent of sports related eye injuries can be prevented with appropriate eye protection.

How frequently do injuries occur from basketball?

In any given year, approximately 1 in 10 basketball players will sustain an eye injury. Most injuries are corneal abrasions caused by opponentŐs fingers or elbows striking a player's eye usually during aggressive play under the boards. More severe injuries can occur including retinal detachments and even tearing the optic nerve. Again, almost all of these injuries can be prevented by protective eyewear. It has become more fashionable to use protective eyewear in basketball since several high profile NBA players have adopted this habit.

Should women not wear eye make up when playing a sport?

If the eye makeup runs with perspiration, there is a good chance that it will eventually get into the eye. Some types of makeup will be quite irritating to the eye and this could decrease your performance of playing the sport. There is really no absolute contraindication to wearing makeup while playing a sport, however.

Can blind people participate in athletics?

Over the last 20 years, there has been a major increase in sports activities available for blind athletes. These include track and field, wrestling, gymnastics and several specialty sports such as beep baseball and goal ball. This is a fast paced game developed especially for blind athletes in which a 4-1/2 pound ball containing bells is rolled on a 30 by 60 foot mat passed opposing players across an end zone. Blind athletes also participate in golf and skiing.

What is the role of sports visual training?

Some people believe that one can increase their performance in sports by training their eyes to "react better". There are quite extensive training courses on the subject, but the results have been quite difficult to interpret. Some claim that visual training improves athletic performance. However, a key question remains. Would the same amount of time spent with a good coach under actual game conditions result in a better final performance than that same amount of time spent with visual training? The answer to this question is yet unclear.

Do different sports injuries occur at different ages, do children get the same eye injuries as adults?

Most sports injuries occur in individuals under age 25 and almost half of injuries occur in people under age 15 and 6 percent of injuries occur in children under age 5. Younger children, from age 5 to 14, have about 20 percent of their injuries from baseball. Overall, sports most commonly associated with eye injuries in adults are baseball, basketball, soccer, football and hockey. Younger children are more susceptible to severe eye trauma because of their athletic maturity and overall fearless attitude towards participation.

In summary, sports are to be enjoyed by all, but will certainly be enjoyed more fully if one still has their vision at the end of the day. The best way to assure this is to use protective sports wear, appropriate for your individual sport. Your eye care practitioner should be able to advise you in the appropriate eye protection. Thank you.

See related Patient Topics Eye Injuries, Eyes and Vision, Injuries and Wounds, Sports Injuries or Wellness and Lifestyle.

See related Provider Topics Eye Injuries, Eyes and Vision, Injuries and Wounds, Sports Injuries or Wellness and Lifestyle.

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