When I was a medical student working at the Royal Victorian Eye and Ear Hospital (Eye and Ear) Emergency Department (ED) with Dr Rahul Chakrabarti and A/Prof Carmel Crock, we were shocked by the large number of patients who were presenting with sports-related eye injuries. However, when we searched the literature, we found that there were no recent large-scale studies in Australia assessing the characteristics of these injuries. To better understand the mechanism and pattern of eye injuries that occur during sporting activities, we performed our own sports-related eye trauma study.
We assessed cases of patients who presented to Eye and Ear ED between 2015 and 2020, examining various data including patient demographics, injury mechanism, injury characteristics and investigations and management performed. To our surprise, we found 1,793 cases of sports-related eye injury. Our results showed that sports-related eye trauma disproportionately impacts younger individuals with a mean patient age of 28 years and 30% of patients being paediatric. Over 80% of patients were male and winter was the most common season for presentations.
Soccer was the leading sport to cause injuries (18% of cases), followed by AFL (17% of cases) and basketball (12% of cases). These were also the top three sports to cause injury in the paediatric population. The use of protective eyewear is not mandatory in any of these sports, likely contributing to the high number of presentations. In contrast, paintball, where the use of a face shield in Australia is mandatory, was the sport to cause the least number of eye injuries, contributing only 0.3% of cases.
The most common mechanisms of injury were a projectile object such as a ball (54% of cases), incidental body contact such as a finger or elbow (28% of cases) and sporting equipment such as a racket (6% of cases). The most common pathologies observed were hyphaema and traumatic uveitis, followed by commotio retinae, corneal injuries (such as abrasions and lacerations) and conjunctival injuries (such as subconjunctival haemorrhage). Only 27 patients were admitted to hospital and 26 patients required surgery. The most common sport contributing to surgical cases was AFL and the most common injury requiring surgery was globe rupture/ penetration. The most common non-surgical management was steroids and cycloplegics.
Multivariate logistic regression showed that the greatest risk of globe rupture or penetration was associated with martial arts, orbital blow-out fracture with skiing, hyphaema with squash, and retinal tears with foam dart projectiles. When planning targeted prevention strategies, it is not only important to consider the relative frequency of injuries caused by a specific sport, but also the relative severity of injuries caused by that sport.
Ocular injuries and their sequelae can predispose patients to long-term physical, psychosocial and health- economic impacts. The reduction of ocular injury requires a coordinated effort from the community including public health professionals, policy makers and role model athletes to encourage a safer sporting culture. Collingwood AFL player Mason Cox – who wears specially-made eyewear during matches after extensive surgery on both eyes – comes to mind as a sporting star that is helping to progress the conversation around safety eyewear in sport.
Although elimination of hazards remains the most effective way to prevent injuries, it is also important to educate children regarding hazard awareness and safe play, as well as encouraging the use of standardised protective eyewear. Not only is further research required to identify areas for intervention, but it is also important for us as health professionals to document whether there was use of protective eyewear so that we are able to examine the impact of the changes we make.
ABOUT THE AUTHOR:
Name: Dr Gizem Ashraf
Qualifications: BMedSci/MD
Organisations: Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital
Position: Doctor
Location: Melbourne
Years in profession: 2
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