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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.

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Box 36-1 When to Refer. 
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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.

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Table 36-1. Recommended Eye Protectors for Selected Sports* 

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