Changing trends in paintball sport-related ocular injuries

Ocular injuries from drive-by paintball shootings

PURPOSE

To characterize ocular injuries from drive-by paintball shootings with a focus on the severity of injuries sustained, clinical management, and visual outcomes.

DESIGN

Retrospective, interventional case series.

METHODS

Setting: University practice and emergency department.

PATIENT POPULATION

Patients evaluated by the ophthalmology service for paintball injuries.

OBSERVATION PROCEDURE

Age, gender, eye laterality, mechanism of injury, initial best-corrected visual acuity (BCVA), and initial diagnosis.

MAIN OUTCOME MEASURES

Clinical intervention(s), BCVA at last follow-up visit, and severity of injuries with a focus on ruptured globes.

RESULTS

Twenty patients suffered unilateral ocular injuries from drive-by paintball shootings between January 2020 and December 2021. Median follow-up interval was 7.1 weeks (range: 3 days - 11.4 months). Average patient age at presentation was 36.6 years (range: 13 - 64 years-old). Fourteen patients (70%) had an initial BCVA of counting fingers (CF) or worse. Six patients (30%) suffered ruptured globe injury requiring surgical repair, of whom three (15%) underwent subsequent evisceration. Twelve patients (60%) suffered ocular injuries requiring surgical intervention. Fifteen ocular surgeries were performed on 9 patients (45%) at our institution with 3 patients referred to outside providers for definitive surgical management due to insurance. BCVA at last-follow up visit was no light perception (NLP) in five patients.

CONCLUSIONS

The severity of injury following paintball-induced ocular trauma is higher in this case series than what has previously been reported in the literature. Paintball guns can cause devastating ocular injury when used as an assault weapon and their use in unregulated settings bears further scrutiny.

Toy gun eye injuries - eye protection needed Helsinki ocular trauma study

PURPOSE

We report the epidemiology, findings, treatment, long-term outcome and use of resources for eye injuries caused by toy guns in southern Finland.

METHODS

All new patients injured by toy guns in one year (2011-2012) and treated at Helsinki University Eye Hospital were included. Follow-ups occurred at 3 months and 5 years.

RESULTS

Toy guns caused 15 eye traumas (1% of all eye traumas). Most patients were male (n = 14) and children aged under 16 years (n = 13). Toy guns involved were airsoft guns (n = 12), pea shooters (n = 2) and paintball (n = 1). Eleven patients did not use protective eyewear, and four patients discontinued their use during the game. Seven patients were not active participants in the game. Blunt ocular trauma was the primary diagnosis in 13 patients and corneal abrasion in two. Seven patients had retinal findings. In the 5-year follow-up, eight of 15 patients had abnormal ocular findings: three had artificial intraocular lens, two iridodialysis, and one each retinal plomb, mydriasis or iris tear. None had glaucoma. Seven patients had permanent subjective impairment due to pain, lowered visual acuity, blur or difficulty in focusing. Four patients needed seven operations. The number of outpatient visits was 90. One patient required hospitalization.

CONCLUSION

Toy guns cause serious eye traumas. No glaucoma was found. Proper use of toy guns and protective eyewear during the whole game should be emphasized to both players and bystanders. We recommend that in Finland the selling of airsoft guns be placed under the Firearms Act to make the hazards of airsoft guns known.

Paintball related ocular injuries: First case report in Saudi patients

Paintball is a popular recreational sport. This case series describes three Saudi patients exposed to paintball ocular injuries with sever ocular trauma. Two patients developed hyphema and traumatic cataract and one patient had vitreous hemorrhage, choroidal detachment, commotio retinae and retinal tear. All patients require surgical intervention. Final best corrected visual acuity was 20/200, 20/30 and 20/50 respectively. Paintball related ocular injuries can result in severe visual loss and in most of the time requires surgical intervention. Most injuries occur in under-supervised settings and are easily preventable. Our main aim was to increase awareness among local ophthalmologists and eye professionals about this new game. Improved safety measures and appropriate public education could prevent such serious ocular injuries.

Paintball-related ocular trauma: Paintball or Painball?

BACKGROUND

The aim of this study is to describe the type and severity of paintball-related ocular trauma and to determine the necessary precautions to minimize the risk of ocular injury regardless of whether adequate eye protection was used.

MATERIAL AND METHODS

A retrospective chart review identified patients treated for paintball-related ocular trauma at the Ataturk University Medical Hospital from June 2010 through March 2013. A descriptive analysis of data was performed.

RESULTS

Ten patients with paintball-related ocular trauma were identified. At the time of their first examination, 7 of these patients had visual acuity (VA) of 20/200 or worse. One patient had a final VA of no light perception and 4 patients had a final VA of 20/200 or worse. Hyphema was noted in 7 patients, traumatic cataract in 2, iridodialysis in 2, retinal detachment in 3, and secondary glaucoma in 1. Six patients required surgery. Although all victims have used eye protection during the game, all patients were injured after they thought the game was over and had taken off their helmets or eye-protective devices.

CONCLUSIONS

Paintball-related accidents result in serious ocular trauma and most of the patients require surgery. These injuries result in severe loss of VA in some patients. Uninterrupted use of proper eye protection whenever a player is in the game field, even after they believe the game has ended, may reduce the incidence of severe ocular trauma in paintball players.

A survey of ocular sports trauma and the role of eye protection

PURPOSE

The incidence of sports associated ocular injuries presenting to emergency departments is rising. Despite this, eye protection is not widely used in the general population. This survey was conducted to determine the spectrum of ocular sports injuries that presented to the emergency department of an ophthalmic hospital, which serves a large sector of inner city London. The role of eye protection in preventing ocular sports injuries was also investigated.

METHODS

All patients who attended the emergency department with sports associated ocular injuries between May and July 2008 were identified. Medical records of these patients were examined.

RESULTS

There were a total of 16999 ophthalmic emergency attendances. 48 (0.28%) patients presented with sports related ocular injuries. The outcomes of the consultations were: 13 (27.1%) patients discharged from the emergency department, 17 (35.4%) had reviews arranged in the emergency department, 18 (37.5%) referred to subspecialties. The mean presenting LogMAR visual acuities of patients that were discharged, reviewed in the emergency department, and referred to subspecialties were 0.01 (±0.33), 0.48 (±0.75), and 0.31 (±0.61) respectively. Visual acuities were better by 0.39 (95% CI 0.01-0.77, p=0.042) in patients who were discharged compared to patients who were reviewed in the emergency department or referred to subspecialties. Evaluation of records revealed that no patients wore eye protection and none were given advice regarding prevention of future injuries.

CONCLUSION

Results from this survey show that ocular sports injuries account for a proportion of ophthalmic emergency attendances with a potential impact on service provision. It is essential that ophthalmologists, optometrists and other healthcare professionals are aware of the potential ocular morbidity from sports trauma and the importance of providing advice on the prevention of such injuries.

Ocular trauma and visual outcome secondary to paintball projectiles

PURPOSE

To describe ocular injuries attributable to paintball-related trauma and their management and results.

DESIGN

Retrospective, interventional case series.

METHODS

setting: University practice and emergency department. patient population: Thirty-six eyes of 36 patients who sustained ocular injuries secondary to paintballs between July 1, 1998 and January 1, 2005. observation procedure: Age, gender, laterality, setting, eye protection, best-corrected visual acuity (BCVA), and initial diagnosis were documented. main outcome measures: Medical and surgical intervention within the first three days postinjury and further treatment after this time period were recorded. BCVA at the initial and final clinical visit were compared.

RESULTS

The mean follow-up interval was 11.7 months (one to 40). Mean age was 21 years (three to 64), 31 (86%) were male, 34 (97%) were not wearing eye-protection device when injured, and initial BCVA was worse than 20/200 in 28 eyes (78%). The most common ocular finding was hyphema in 29 eyes (81%). Initially, 20 eyes (56%) were managed medically and nine eyes (25%) required primary repair of a ruptured globe. Ultimately, 29 eyes (81%) had surgical intervention including eight eyes (22%) enucleations. Final visual acuity was 20/40 or better in 13 eyes (36%), whereas 18 eyes (50%) were worse than 20/200. Visual acuity (VA) at initial presentation correlated strongly with final VA (r = 0.64; P < .001).

CONCLUSIONS

Paintball-related ocular injuries are frequently severe and visually devastating. The compulsive use of protective eyewear may have eliminated 97% of injuries in this series and continues to need emphasis to paintball users.

Traumatic aneurysm of the occipital artery secondary to paintball injury

Paintball is an "extreme sport" that has been steadily growing in popularity since the early 1980s. Although this activity is considered recreational, there are a number of inherent dangers associated. Most notably, the number of head and neck injuries due to paintball participation has been increasing in recent years. In this paper we present the first reported case of occipital artery traumatic pseudoaneurysm resulting from a paintball accident. The presentation, diagnosis and intraoperative findings are detailed. A discussion including a review of the literature is also presented. The authors recommend a re-evaluation of guidelines within the paintball sporting industry, including improvements in protective equipment.

Ocular findings following trauma from paintball sports

PURPOSE

To raise awareness of potential significant ocular damage and visual loss secondary to paintballs in those not wearing ocular protection and to report high incidence of chorioretinitis sclopetaria from paintball contusion.

METHODS

We reviewed cases of eye injury presenting to a single institution from 2000 to 2005. Those cases in which the injury was attributed to paintballs were identified and evaluated to determine ocular findings and visual prognosis.

RESULTS

Ocular paintball injuries occurred in eight male subjects and one female subject (nine eyes) with an average age of 16 years (range, 11-26). None had ocular protection at the time of ocular injury. On initial examination, vitreous haemorrhage was present in six eyes (67%), maculopathy, hyphema, cataract, and commotio retinae were each present in four eyes (44%). Two eyes suffered retinal detachment and one eye an optic nerve avulsion. Chorioretinitis sclopetaria occurred in four eyes (44%). The final visual acuity was > or =20/40 in three eyes, 20/50 to 20/150 in two eyes, and < or =20/200 in four eyes.

CONCLUSION

Injuries owing to paintballs can result in severe ocular damage and visual loss. Increased awareness and need for proper ocular protection should be emphasized by ophthalmologists. Chorioretinitis sclopetaria occurs with a high frequency and its presence should be recognized, as its management is different from retinal tear or detachment.

Risk functions for human and porcine eye rupture based on projectile characteristics of blunt objects

Eye ruptures are among the most devastating eye injuries and can occur in automobile crashes, sporting impacts, and military events, where blunt projectile impacts to the eye can be encountered. The purpose of this study was to develop injury risk functions for globe rupture of both human and porcine eyes from blunt projectile impacts. This study was completed in two parts by combining published eye experiments with new test data. In the first part, data from 57 eye impact tests that were reported in the literature were analyzed. Projectile characteristics such as mass, cross-sectional area, and velocity, as well as injury outcome were noted for all tests. Data were sorted by species type and areas were identified where a paucity of data existed, based on the kinetic and normalized energy of assaulting objects. For the second part, a total of 126 projectile tests were performed on human and porcine eyes. Projectiles used for these tests included blunt aluminum projectiles, BBs, foam pellets, Airsoft pellets, and paintballs. Data for each projectile were recorded prior to testing and high-speed video was used to determine projectile velocity prior to striking the eye. In part three the data were pooled for a total of 183 eye impact tests, 83 human and 100 porcine, and were analyzed to develop the injury risk criteria. Binary logistic regression was used to develop injury risk functions based on kinetic and normalized energy. Probit analysis was used to estimate confidence intervals for the injury risk functions. Porcine eyes were found to be significantly stronger than human eyes in resisting globe rupture (p=0.01). For porcine eyes a 50% risk of globe rupture was found to be 71,145 J/m2, with a confidence interval of 63,245 J/m2 to 80,390 J/m2. Human eyes were found to have a 50% risk of globe rupture at a lower, 35,519 J/m2, with confidence intervals of 32,018 J/m2 to 40,641 J/m2. The results presented in this paper are useful in estimating the risk of globe rupture when projectile parameters are known, or can be used to validate computational eye models.

33 cases of airsoft gun pellet ocular injuries in Copenhagen, Denmark, 1998-2002

PURPOSE

To evaluate the incidence and ocular effects of blunt trauma due to injury from airsoft gun pellets.

METHODS

We conducted a non-comparative case series based on the files of 33 patients who suffered ocular injury from airsoft guns and were admitted to one university emergency eye clinic in Copenhagen during a 5-year period.

RESULTS

A total of 33 eyes in 33 patients were examined. Thirty male and three female patients were affected. Mean age was 13 years (range 3-49 years). Mean follow-up time was 6.5 days (range 1-540 days). On initial examination, we found: hyphaema (n = 28), corneal abrasion (n = 22), retinal oedema (n = 11), subconjunctival haemorrhage (n = 10), palpebral haemorrhage and/or oedema (n = 9), iris dialysis (n = 7), intraocular pressure (IOP) > 31 mmHg (n = 4), IOP < 9 mmHg (n = 4), vitreous haemorrhage (n = 2) and cataract (n = 1). One patient had brown corneal discoloration due to severe chronic hyphaema that required surgery. The final visual acuity was 1.0 in 20 patients and < or = 0.7 in five patients.

CONCLUSION

The airsoft gun trauma resulted in anterior and posterior segment ocular injuries that required acute medical intervention and for which some patients were hospitalized. Trauma mainly occurred in children and youths. A longterm risk of glaucoma is expected. Eye care professionals and parents as well as manufacturers of airsoft guns should advise participants to wear adequate protection when involved in this activity.

Circumstance and outcome of ocular paintball injuries

PURPOSE

To determine the circumstance and outcome of ocular injuries attributable to paintball projectiles.

DESIGN

Retrospective interventional case series.

METHODS

Institutional review board approved retrospective chart review of 19 consecutive eyes with paintball injuries with minimum follow-up of 3 months.

RESULTS

Ten eyes (53%) had final visual acuity of 20/40 or better, while seven (36%) were 20/200 or worse. Ten eyes were injured in paintball games, (two formal and eight informal), while nine (47%) were injured by accidents or assaults not associated with any "game."

CONCLUSIONS

Paintball injuries often cause severe and permanent visual loss. Nearly half of these injuries occur outside a war game setting as accidents or assaults.

Injury risk of nonpowder guns

Nonpowder guns (ball-bearing [BB] guns, pellet guns, air rifles, paintball guns) continue to cause serious injuries to children and adolescents. The muzzle velocity of these guns can range from approximately 150 ft/second to 1200 ft/second (the muzzle velocities of traditional firearm pistols are 750 ft/second to 1450 ft/second). Both low- and high-velocity nonpowder guns are associated with serious injuries, and fatalities can result from high-velocity guns. A persisting problem is the lack of medical recognition of the severity of injuries that can result from these guns, including penetration of the eye, skin, internal organs, and bone. Nationally, in 2000, there were an estimated 21840 (coefficient of variation: 0.0821) injuries related to nonpowder guns, with approximately 4% resulting in hospitalization. Between 1990 and 2000, the US Consumer Product Safety Commission reported 39 nonpowder gun-related deaths, of which 32 were children younger than 15 years. The introduction of high-powered air rifles in the 1970s has been associated with approximately 4 deaths per year. The advent of war games and the use of paintball guns have resulted in a number of reports of injuries, especially to the eye. Injuries associated with nonpowder guns should receive prompt medical management similar to the management of firearm-related injuries, and nonpowder guns should never be characterized as toys.

Modern sports eye injuries

AIMS

To determine the severity and long term sequelae of eye injuries caused by modern sports that could be responsible for significant ocular trauma in the future.

METHODS

Prospective observational study of 24 (25 eyes) athletes with sports related ocular injuries from health clubs, war games, adventure, radical and new types of soccer, presenting to an eye emergency department between 1992 and 2002 (10 years).

RESULTS

Modern sports were responsible for 8.3% of the 288 total sports eye injuries reported. Squash (29.2%) was the most common cause, followed by paintball (20.8%) and motocross (16.6%). The most common diagnosis during the follow up period was retinal breaks (20%). 18 (75%) patients sustained a severe injury. The final visual acuity remained <20/100 in two paintball players.

CONCLUSIONS

Ocular injuries resulting from modern sports are often severe. Adequate instruction of the participants in the games, proper use of eye protectors, and a routine complete ophthalmological examination after an eye trauma should be mandatory.

Paintball injuries in children: more than meets the eye

OBJECTIVE

To describe the increasing incidence of ocular injuries in the pediatric population caused by paintballs. The awareness of this trend will help the physician who treats the child to give appropriate care as well as educate physicians, who counsel children, about this growing mechanism of pediatric injuries.

METHODS

Previously unpublished data from the US Consumer Product Safety Commission were analyzed to find the frequency of ocular injuries in children. A review of the English-language literature was also conducted to describe trends with regard to age, sex, location at the time of injury, use of eye protection, types of injuries sustained, and long-term visual outcome.

RESULTS

The incidence of paintball eye injuries treated in emergency departments has risen from an estimated 545 in 1998 to >1200 in 2000. The proportion of these injuries that occurred in the pediatric population may be well over 40%. These injuries are seen predominantly in boys, a growing proportion of whom are playing informally in unsupervised settings and not wearing eye protection. The cases previously reported include large numbers of hyphemas, retinal detachments, cataracts, corneal abrasions, vitreous hemorrhages, and commotio retina. Many of the patients in these cases sustained permanent visual impairment, with 43% having best vision at follow-up of 20/200 or worse.

CONCLUSIONS

Pediatric eye injuries caused by paintballs are an unrecognized cause of severe injury and permanent visual loss. The advances in eye protection for participants in "war games" have had little if any effect on the youngest population. Children and teens are unlikely to wear eye protection voluntarily when playing at undesignated or unsupervised locations. Changes should be made to restrict availability of these very dangerous but easily acquired guns and ammunition. Practitioners must counsel young people and their caregivers to avoid injuries by wearing appropriate eye protection. Parents should supervise the use of paintball equipment as they would other activities that involve high-speed projectiles.

Ocular paintball injuries

Paintball sport-related ocular injuries represent an increasing problem as the popularity of the sport increases and the number of participants grows. Although eye protective devices designed specifically for paintball sports are extremely effective in preventing such injuries, the failure to properly wear these devices has resulted in an alarming number of severe ocular injuries. Recent trends have indicated that an increasing percentage of paintball sport-related ocular injuries have occurred in unsupervised, noncommercial settings (i.e., backyard games) where the use of eye protective devices is not required. Paintball industry standards for eye protection have recently been developed and should be implemented for all participants.

Contusion injuries and their ocular effects

A 22-year-old female optometry student presented with a one-day history of a contusion injury to the right eye with blurred vision inferiorly. Slitlamp examination showed mild anterior chamber reaction. Angle recession was visible by gonioscopy and dilated fundus examination revealed commotio retinae with macular involvement and vitreal haemorrhages. Peripheral retinal tears were later detected. The management of a patient with a history of a contusion injury is discussed.