This article is more than 5 years old. Information may no longer be current.
Back in school, kids’ eyes may be safer
Organized sports are a less common cause of childhood eye injury than home accidents. But sport-related trauma is still a serious risk.
Click Here to Manage Email Alerts
![Back to School 2005 [logo]](/~/media/images/news/print/ocular-surgery-news/2005/08_august_1/backtoschool_275_93_6019.gif)
A young boy is more prepared to expect a line drive during a Little League game than to be hit in the eye by a toy car thrown by his little sister as he surfs the Internet. But household trauma is a more common cause of eye injury than organized sports.
According to Ferenc Kuhn, MD, president of the American Society of Ocular Trauma, young students in the United States spend less time playing organized sports and more time indoors, where the majority of ocular traumas now occur.
"If you look at where injuries occur, very few occur at school because we do pay attention to behaviors and risk factors at school," Dr. Kuhn said. "Summer is a more dangerous period than the fall, and parents should probably be a little more at ease with their children being at school than with them being outside and playing with outdoor toys.
"Sports are obviously a major cause of injury, although it is probably not as common as one would think, and that's somewhat surprising to us as well," he continued. "Play is probably more important than sports [as a source of ocular trauma]. The reason for that is that at least during sport, there is some recognition of the fact that this might be dangerous."
Sport injuries
Even with a heightened awareness of eye safety in organized sports, team play can still be a source of serious ocular trauma. Basketball is consistently one of the top causes of sports eye injury in the United States, according to Dr. Kuhn.
"It's supposed to be a noncontact sport, but I recently saw a case of a ruptured eye that had no lens, vitreous or iris," he said. "Is it logical to have something protecting the eye? The answer is yes."
Protective goggles can protect the eyes from flailing fingers during play, but they are rarely worn.
"There are specific types of protection for different sports," Dr. Kuhn said. "To me, it's somewhat irresponsible not to wear them or not to at least consider whether it should be worn."
It is difficult to break down the risk of each individual sport, Dr. Kuhn said, because it is not feasible to follow every injury. However, there are measures that can be made to reduce or eliminate risks.
Pediatric ophthalmologist Anthony P. Johnson, MD, said he sees most baseball-related injuries in the spring and summer seasons.
"The typical story is that the coach is hitting fly balls to the outfielders, and the sun is starting to set behind where the coach is hitting," Dr. Johnson explained. "They're holding their glove up, and all of a sudden the ball comes above the glove and hits them right in the eye."
The blunt trauma causes hyphema, he said.
Tennis, squash and racquetball are also higher-risk sports, Dr. Johnson said.
"It depends on the size of the ball and the material," he said. "The smaller the object, the more likely that your bony orbital rim will not protect your eye."
Preventing injury
"When it comes to prevention, which is a lot more important than treatment, we have to understand that there will always be some resistance," Dr. Kuhn said. "Protective eyewear may interfere with performance or presumed performance. For hockey players, the puck is very hard rubber, almost like a rock, and it can travel up to 100 miles per hour. If someone hits you with this, the eye is gone."
Parents, coaches and children often think of things they should have done to prevent an eye injury in hindsight.
"The most important thing to understand related to injury is that humans tend to think that illness, and that includes injury, happens to somebody else," Dr. Kuhn said. "We are somehow not ready to accept that these things happen to all of us and can happen, when it comes to injury, to anybody at any time."
The example he uses in a lecture to a class of 200 people is that if 10 of them had diabetes when they entered the room, they know 190 will not have diabetes upon leaving the room.
"But you can never be certain whether any of us will incur an eye injury while we are in the room," he said. "If this is true for adults, it's even more true for children. If we look at the age and sex ratio, we see most injuries in general happen to young males."
Screening athletes
"Before someone actually participates in a sport, it makes sense to screen the athlete," Dr. Kuhn said. "They may already have some risk factors and may not know it. For example, if the patient is myopic, that eye might be more vulnerable to injury."
If athletes are injured on the field, they and their parents should be educated about their pathologies, Dr. Kuhn suggested.
"I'm not saying that these pathologies or conditions would prevent someone from participating in that sport, but knowing the risks may help you guide them toward another type of game where risk is lower for them," he said. "Sports remain a crucial part of our lives. We want it to be a crucial part of our lives, so there is one area where prevention can do a lot."
High-risk sport
Paintball is not a sport associated with schools, but it is a frequent cause of eye injuries, Dr. Johnson said.
"Paintball [injuries are] typically more serious and more frequent," he said. "Depending on what you read, paintball injuries to the eye result somewhere between one-third and two-thirds of the injuries with permanent visual loss of 20/200 or worse."
Paintball injuries usually occur when children take off their protective eye device because it either fogs up or paint smears across the goggles. While children are not wearing the device and cleaning it, they can get shot in the eye, Dr. Johnson explained.
When the sport was introduced in the mid-1980s, it was played only at professional parks, but sporting goods stores now make the carbon-charged cartridges readily available.
"Now since they are in the home, 80% to 90% of the injuries seen today do not happen at an organized facility," Dr. Johnson said. "They happen in the backyard."
Paintball injuries can include hyphema, iris tears and traumatic cataract.
"Frequently they have either a maculopathy just from trauma to the macula or either a choroidal rupture or traumatic optic neuropathy too," Dr. Johnson said. "It's awful."
In addition, the paint capsule is small enough to fit between the superior and inferior orbital rims.
"One point made in the literature is that it's more dangerous to play badminton in your backyard than it is to play paintball if you have the proper gear in place," Dr. Johnson said. "If you have the right equipment in place, it is very safe. We're not out to bash paintball. It's just that you have control over your own actions, but you don't have any control over what the other guy is doing. That's the danger."
A national shift
The shift to the home as the most frequent site for ocular trauma has occurred over time, Dr. Kuhn noted.
"If we look at statistics from this country about 20 years ago, most injuries didn't occur in the home. For adults it was the workplace, and for children it was somewhere outside," he said. "Now for children the No. 1 place of injury is actually in the home, some 27%."
Supervision may be a significant factor, Dr. Kuhn said.
"It's interesting to see if supervision by parents has an impact on statistics," Dr. Kuhn said. "Some literature will say no, but I suspect that is not quite true because they didn't look at the quality of supervision. We don't know if these injuries occur when the parent is home or not. We don't have statistics on that."
In general, the individual most at risk for injury is a young boy, Dr. Kuhn said.
"School year age in general is definitely a risk period. Although, if we look at the entire population, the average age where most injuries occur is in the third or fourth decade in life, not school," Dr. Kuhn said.
Injury by location
Injuries may vary by geographical region, Dr. Kuhn said.
"You will see the injuries differ vastly in India, for example. A lot of injuries there are from sports and play, which is not the case in the United States because a lot of children spend their time in front of the computer. So immediately you can see a huge difference in cause," he said.
"Believe it or not, one of the most common sources of eye injury in India is needles," Dr. Kuhn said. "In that country, people throw away used needles, and if children play around trash areas they find them and use them."
For Your Information:
- Ferenc Kuhn, MD, can be reached at 1201 11th Ave. South, Suite 300, Birmingham, AL 35202; 205-558-2588; fax: 205-933-1341; fkuhn@mindspring.com.
- Anthony P. Johnson, MD, can be reached at 601 Halton Road, Greenville, SC 29607; 864-458-7956; fax: 864-458-8390.
- Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology.
- Nicole Nader is an OSN Correspondent based in Philadelphia.