Of the 100,000 eye injuries that occur annually, 40% occur during sports or recreational activities.1 Foreign bodies and lacerations are the most common and generally can be treated by the pediatrician. Globe lacerations, retinal hemorrhage, and retinal detachments can lead to permanent vision loss and should be referred to an ophthalmologist (Box 36-1). Orbital hemorrhage and hyphema can look dramatic but usually resolve with minimal treatment.
Box 36-1 When to Refer. |Favorite Table|Download (.pdf)
Box 36-1 When to Refer.
Recommended Referral for Eye Injuries in Sports
Visible foreign object not easilyremoved with cotton or tissue
Embedded foreign object
Slit-lamp examination may be required with small spud for removal
Loss of vision
Irregularity of the globe
Laceration of the globe
Surgical repair of the globe
Herniation of viteous of eye
Full thickness laceration of the eyelid
Proptosis interfering with vision
Hemorrhage and swelling
Orbital hemorrhage with increased intraocular pressure
Intraocular pressure measurement
Totally black anterior chamber
Hyphema large or not resolving in 3 days
Hemorrhage aspiration may be necessary
Loss of visual field
Persistent blood in the anterior chamber
Irregularity of retina on ophthalmoscopic exam
May need surgical/laser repair
Loss of part of visual field
Loss of vision in one eye
Irregularity of the pupil
Surgical reduction and repair
Blurred vision with upward gaze only
Inability to gaze upward with involved eye
Fracture of the floor of the orbit
Surgical reduction and repair of sinus
Use of appropriate protective eyewear will decrease the risk of corneal abrasion. Good supervision, equipment of good repair, and rules enforcement can further decrease the risk of these eye injuries. For outdoor sports, the area should be inspected for potential obstacles such as tree branches. Appropriate eye protection should be used in high-risk sports such as hockey, football, baseball, softball, basketball, tennis, racquet sports, lacrosse, and swimming. Regular glasses and contacts are not adequate protection. The eye wear should include lenses of polycarbonate 3 mm thick. Frames should be of polycarbonate and molded to the temples, not hinged. Lens treatment with fog resistance will improve vision under environmental conditions (Table 36-1). Proper fitting by an experienced ophthalmologist may improve compliance. Full face protectors either of polycarbonate shield or wire cage should be used in hockey. Wire cage face protectors are most commonly used in lacrosse and football.
Table 36-1. Recommended Eye Protectors for Selected Sports* |Favorite Table|Download (.pdf)
Table 36-1. Recommended Eye Protectors for Selected Sports*
Minimal Eye Protector
Baseball/softball, youth batter or base runner
Face guard attached to helmet
ASTM F803 for baseball
ASTM specifies age ranges
ASTM F803 for basketball
ASTM specifies age ranges
Helmet plus streetwear ANSI Z80, industrial ANSI Z87.1, or ...
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