Eye Injury in Sport

Eye injuries in sport range from minor periorbital bruising to sight-threatening emergencies, and most serious ones are preventable with sport-specific polycarbonate eye protection.

Risk is highest in racquet sports, hockey, cricket, combat sports, cycling and projectile sports. The first questions are whether the injury threatens sight, whether there is an associated head or neck injury, and whether the mechanism could have left an intraocular foreign body.

The orbit is a pyramidal cavity formed by 7 bones. The orbital floor and medial wall (lamina papyracea) are thin and fracture first in blunt trauma, decompressing the orbit and protecting the globe (the blow-out mechanism). The globe is a closed, pressurised chamber, so any full-thickness corneal or scleral wound is an open globe.

Common sport-related injury patterns:

• •Corneal abrasion: fingernail, branch or foreign body; painful but usually heals in 24 to 48 hours
• •Subconjunctival haemorrhage: cosmetic, but rule out associated injury
• •Hyphaema: blood in the anterior chamber after blunt trauma, with risks of rebleeding, raised intraocular pressure (IOP) and corneal staining
• •Intraocular foreign body: a high-velocity projectile (BB pellet, metal fragment); the eye may look deceptively normal
• •Paediatric white-eyed trapdoor: an elastic floor snaps back and traps the inferior rectus, with few external signs but marked diplopia and an oculocardiac reflex (bradycardia, nausea)
• •Commotio retinae (retinal whitening; prognosis depends on the macula) and traumatic iritis (pain and photophobia days after injury)