Sports-Related Eye Injuries

Sports Eye Trauma: Scope & Risks - Ballpark Figures

• Significant cause of preventable vision loss; sports contribute to a large percentage of all eye injuries, potentially up to 40%.
• Common Sports & Injury Patterns (India):
  • Cricket: Ball (severe blunt trauma - hyphema, orbital #, retinal detachment); Bails/wickets (penetrating trauma).
  • Badminton: Shuttlecock (blunt trauma, hyphema).
  • Football: Ball/Limbs (blunt trauma, periorbital hematoma, orbital #).
  • Hockey: Ball/Stick (severe blunt/penetrating trauma).
  • Gilli-danda: Gilli (high-velocity projectile - penetrating/perforating injuries).
• High-Risk Groups: Children & young adults (peak incidence 10-30 years).
• Key Risk Factors:
  • Lack of/improper protective eyewear (primary modifiable factor).
  • Small, high-velocity projectiles.
  • Direct physical contact.

⭐ Cricket ball injuries are notorious for severe blunt trauma, often leading to hyphema or orbital fractures.

Common Sports Injuries: Types & How - Damage Report

• Hyphema: Blood in anterior chamber (AC). Common: shuttlecock injury.
  • Grading: Grade I (<1/3 AC), Grade II (1/3-1/2 AC), Grade III (>1/2 AC), Grade IV (total/8-ball).
• Orbital Blowout Fracture: Floor/medial wall. Common: ball impact.
  • 📌 Signs: D.I.E. (Diplopia, Infraorbital anesthesia, Enophthalmos).
• Corneal Abrasion: Superficial epithelial defect. Common: finger poke.

⭐ Blowout fractures most commonly involve the orbital floor due to its structural weakness, leading to potential entrapment of inferior rectus muscle.

Diagnosis in Action: Eye Exam Steps - Detective Work

• History: Mechanism (blunt/penetrating), symptoms (pain, ↓vision, diplopia), prior eye Hx, tetanus, eyewear.
• Examination (Systematic):
  • Visual Acuity (pinhole).
  • External: Lids, adnexa, proptosis, enophthalmos, crepitus.
  • Pupils: RAPD, shape, size, reactivity.
  • Motility: Restrictions, diplopia.
  • IOP: Defer if open globe.
  • Slit-lamp: Anterior segment; Seidel test (+ve = perforation).
  • Fundoscopy: Posterior segment (vitreous hemorrhage, retinal detachment/tears).
• Key Signs:
  • Open Globe: Teardrop pupil, +ve Seidel, 360° SCH, uveal prolapse.
  • Blowout Fx: Restricted EOM, infraorbital anesthesia.
  • Blackball hyphema.
• Investigations: B-scan (opaque media), CT scan (orbital #, IOFB).

⭐ RAPD with good VA suggests significant optic nerve/retinal damage.

Treatment & Safety: Saving Sight - Shield & Heal

• Immediate/First Aid
  • DOs: Rigid shield, rest, head up 30-45°.
  • DON'Ts: NO pressure patch (open globe), NO rubbing, NO removing foreign body, NO food/drink if surgery.
• Management Highlights
  • Corneal Abrasion: Topical antibiotics, cycloplegics. NO STEROIDS if infection.
  • Traumatic Hyphema: Bed rest, head up 30-45°, cycloplegics, steroids, IOP control. Surgery: total, uncontrolled IOP, corneal stain, persistent Grade II-IV >5-7d.

-   Orbital Blowout: Nasal decongestants, oral antibiotics. No nose blowing. Surgery: diplopia, enophthalmos >**2mm**, large fracture, entrapment.
-   Open Globe Injury: EMERGENCY! Rigid shield, NPO, IV Abx, antiemetics, tetanus. Surgery ASAP (<**24**h). 📌 SHIELD N' PRAY (Shield, NPO, Pain relief, Refer, Antiemetics/Abx, Tetanus).

• Prevention
  • Protective eyewear (polycarbonate, ASTM F803).
  • Patient education.
  • Modifying sports rules.

⭐ Pressure patching is contraindicated in suspected penetrating eye injuries; may extrude intraocular contents.

High‑Yield Points - ⚡ Biggest Takeaways

• Blunt trauma is the predominant mechanism in sports-related eye injuries.
• Hyphema is common, carrying risks of re-bleeding and secondary glaucoma.
• Orbital blowout fractures, typically the inferior wall, may cause diplopia and enophthalmos.
• Commotio retinae (retinal bruising) can lead to transient or permanent vision impairment.
• Protective eyewear is paramount for prevention, especially in sports like squash, hockey, and cricket.
• Always rule out open globe injury in cases of significant trauma or uveal prolapse.