Eye injuries in racket sports

A Systematic Review on the Effectiveness of Eyewear in Reducing the Incidence and Severity of Eye Injuries in Racket Sports

PURPOSE

To assess what eyewear (if any) reduces eye injury incidence and severity in squash, racketball, tennis and badminton.

DESIGN

Systematic review following the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) and the 'implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science' (PERSiST) guidelines.

METHODS

PubMed, SportDiscus and Web of Science were searched on 22nd February 2023. All study types except reviews were eligible. Studies had to report the type of eyewear worn (if any) with a form of eye injury incidence and severity.

RESULTS

364 papers were initially retrieved and after the screening process 29 remained. A subgroup analysis was carried out on studies that had a sample size of five or above, were not only looking at a particular type of eye injury and that had sufficient data to allow the percentage of eye injuries that occurred when no eyewear was worn to be calculated. From this analysis, the median percentage of eye injuries that occurred when no eyewear was worn was found to be 93%. Some of these injuries were serious and required complex treatment. Prescription lenses, contact lenses and industrial eyewear made some injuries more severe. In squash and racketball, lensless eye guards were ineffective as the ball could deform on impact, still making contact with the eye. Only eyewear compliant with updated ASTM (or similar) standards was associated with no eye injuries and so provided adequate protection in all four sports.

CONCLUSIONS

Although this systematic review only summarizes evidence on injuries requiring hospital treatment, it is recommended that national governing bodies and key decision makers within squash, racketball, tennis and badminton examine the evidence presented and consider extending existing rules or implementing new recommendations and policies on protective eyewear use to reduce eye injury incidence and severity in their sport.

Sports-related ocular injuries. A three-year follow-up study

PURPOSE

The authors performed a sports-related ocular injuries evaluation with periodic patient observation and follow-up, to outline the severity and long-term sequelae of eye injuries in sports.

METHODS

A prospective study was conducted of 84 consecutive patients (85 injured eyes) with sports-related eye injuries examined at the Eye Emergency Department of Porto S. João Hospital, between April 1992 and March 1995. The ophthalmologic examination was recorded using the United States Eye Injury Registry report forms, and the follow-up ranged from 3 months to 3 years.

RESULTS

Injuries occurred predominantly in young males (mean age, 24.8 +/- 9.6 years). The type of sport and the mechanism most frequently responsible for injuries were, respectively, outdoor and indoor soccer (72.6%) and ball trauma (64.3%). Of 45 patients presenting with hyphema, 24 (53.3%) had vitreous and/or retina (V/R) lesions (95% confidence interval [CI], 35.8-67.5) compared with 13 of 39 (33.3%) patients with no hyphema (95% CI, 20.0-49.1). Angle recession was significantly more common in the presence of hyphema (55.6%; 95% CI, 41.0-69.5 vs. 10.3%; 95% CI, 3.3-22.9; P < 0.00005), and retinal tears were more common in the presence of vitreous hemorrhage (P = 0.004). Nineteen of 58 (32.8%) patients with "normal" visual acuity (> or = 20/40) presented with V/R lesions. Hyphemas were significantly more frequent in soccer players (38/61 vs. 7/23, P = 0.018).

CONCLUSION

These results highlighted the serious nature of outdoor and indoor soccer injuries. The severity of the anterior segment injury was not a good predictor of posterior segment damage. Ophthalmologists can help prevent delayed consequences by including regular gonioscopy and peripheral retinal examination in all cases of blunt trauma. The United States Eye Injury Registry report forms adapted to sports proved to be a useful tool for collecting detailed information and sharing a common database.

Ocular protection in squash clubs: time for a change?

All squash clubs in the West Midlands were surveyed by postal questionnaire to determine their level of awareness to the risk of ocular injury. Of the 100 clubs surveyed, 51 questionnaires were returned. None of the clubs responding had any information warning of the potential hazards of ocular injury. Thirteen of the clubs had sporting goods shops; of these, three sold protective eye-wear. Significantly, all three stocked the open or lenseless type of eye-guard and only one had the guards with impact-resistant plastic lenses. The majority of clubs (96%) expressed a desire for further information. It is concluded that: (1) players are not warned of the hazards of playing without appropriate eye protection, (2) hazardous eye-guards (open type) continue to be sold, and (3) there is a desire to improve the safety of the sport.

Sports-related ocular trauma

A prospective evaluation of all patients presenting with a sports-related ocular injury during a 1-year (4-season) period was conducted. Of the 202 patients evaluated, 28 (13.8%) required hospitalization and 11 (5.6%) required intraocular surgery. Twenty-six patients (12.8%) sustained permanent ocular sequelae including seven (3.5%) who suffered visual loss. Basketball accounted for 28.7%, baseball/softball 19.8%, and racquetball 11.4% of all injuries. At the time of injury, 5.1% of patients had worn protective eye wear, whereas on follow-up only 31% had used eye protection. These results indicate that sports trauma remains a significant cause of ocular morbidity.

Eye Injuries in Sports: Results of a Five-Year Study

In brief: From 1982 to 1986, Quebec ophthalmologists reported 869 sports-related eye injuries. Hyphema was the most common injury, with a frequency of 33%. Most injuries occurred in ice hockey, followed by racket sports (32% and 28%, respectively); most of the injured players were not wearing eye protection. The authors suggest that wearing eye protection should be mandatory in some sports and encouraged in many others.

Eye Protection in Racket Sports: An Update

In brief: A growing number of eye injuries in squash and racquetball in the late 1970s triggered research on eye protectors for these sports. The investigations showed that lensless eye guards were ineffective and that the frames of some lensed eye guards shattered when hit by a ball. Subsequently, Canadian and US organizations set standards for eye guards, requiring that the devices protect the eye from a ball traveling at 90 mph. Seven commercially available eye guards now meet the Canadian or US standard or both. Polycarbonate is the best lens material for eye guards. There is no substitute for approved eye guards; neither experience nor ordinary prescription glasses nor lensless eye guards provide good protection.

Prevention of ocular gunshot injuries using polycarbonate lenses

Two patients lost three eyes, and one his life, secondary to ocular gunshot wounds. In both patients, the pellets gained entry into the central nervous system through the eye and orbital bones despite only superficial wounds to other areas of the body. These tragic injuries prompted a study of polycarbonate lenses to determine their effectiveness in preventing small caliber ocular gunshot wounds. This investigation determined that 3.0 mm and the 2.2 mm polycarbonate lenses could prevent such injuries at distances greater than 15 yards. In comparing the two lenses, it was found that the 3.0 mm lens sustained less damage at 70 degrees F, but the 2.2 mm lens was more resistant to penetration at 32 degrees F. Since most hunting is done in the fall and winter months, the brittle nature of the thicker lens is significant. Polyamide sports frames with a posterior rim were also tested and found to prevent posterior lenticular expulsion at 15 yards. Standard acetate frames were shown to be ineffective in this regard at 30 yards.