One year of severe eye injuries in sport

A Systematic Review on the Effectiveness of Eyewear in Reducing the Incidence and Severity of Eye Injuries in Racket Sports

PURPOSE

To assess what eyewear (if any) reduces eye injury incidence and severity in squash, racketball, tennis and badminton.

DESIGN

Systematic review following the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) and the 'implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science' (PERSiST) guidelines.

METHODS

PubMed, SportDiscus and Web of Science were searched on 22nd February 2023. All study types except reviews were eligible. Studies had to report the type of eyewear worn (if any) with a form of eye injury incidence and severity.

RESULTS

364 papers were initially retrieved and after the screening process 29 remained. A subgroup analysis was carried out on studies that had a sample size of five or above, were not only looking at a particular type of eye injury and that had sufficient data to allow the percentage of eye injuries that occurred when no eyewear was worn to be calculated. From this analysis, the median percentage of eye injuries that occurred when no eyewear was worn was found to be 93%. Some of these injuries were serious and required complex treatment. Prescription lenses, contact lenses and industrial eyewear made some injuries more severe. In squash and racketball, lensless eye guards were ineffective as the ball could deform on impact, still making contact with the eye. Only eyewear compliant with updated ASTM (or similar) standards was associated with no eye injuries and so provided adequate protection in all four sports.

CONCLUSIONS

Although this systematic review only summarizes evidence on injuries requiring hospital treatment, it is recommended that national governing bodies and key decision makers within squash, racketball, tennis and badminton examine the evidence presented and consider extending existing rules or implementing new recommendations and policies on protective eyewear use to reduce eye injury incidence and severity in their sport.

Eye injuries in badminton - players' perspective toward the usage of personal protective equipment

OBJECTIVE

We conducted a survey between April to September 2021 to understand the perspective of badminton players on the usage of personal protective equipment to avoid eye injuries.

METHODS

The survey was conducted online. It was disseminated through various social media platforms and via e-mail. The survey was initially shared with university-level badminton players. Both recreational and professional players were included. They were further encouraged to circulate the survey questionnaire among their colleagues.

RESULTS

In total, the survey received 372 responses. After removing possible duplicates and incomplete responses (n = 28), 92.5% (n = 344) of the responses were included in the final analysis. Among the 344 included responses, recreational and professional players accounted for 77.6% (n = 267) and 22.4% (n = 77), respectively. The mean age ± SD of the recreational and professional players were 24.1 ± 6.3 years (range 14-60 years) and 25.7 ± 6.0 years (range 14-61 years), respectively. A significant difference was noted for self-reported eye injuries between recreational and professional players while playing badminton (χ2 value = 5.321, p = 0.02). Among the recreational and professional players, 93.6% (n = 250) and 88.3% (n = 68) did not use protective eyewear while playing badminton. Professional players were at higher risk of eye injuries than recreational players (OR = 2.9, 95% CI = 1.1-7.8).

CONCLUSION

The majority of badminton players in both groups agreed that PPE usage would lower the risk of sustaining eye injuries; however, they are ambiguous about the usage of protective eyewear. In contrast, players with self-reported eye injuries were aware of its impacts and encouraged the usage of PPEs associated with badminton. Further studies are warranted to understand and educate badminton players about the causes and impacts of eye injuries in badminton.

Penetrating ocular trauma by nail of a badminton feather shuttle cock: A rare case report

Sports-related ocular traumas may be rare, but can have devastating and disabling consequences. The causes of eye-related injuries depend on the type of sports popular in a particular area or country. Badminton is a popular sport played by all age groups and socioeconomic segments and is popular in many parts of the world. It is most popular in South-East Asia, accounting for two-thirds of all ocular sports injury in Malaysia. In India, badminton has become quite popular in recent years. Shuttlecocks in badminton have been shown to be responsible for a high number of outpatient ocular sports-related, mostly blunt injuries. We report an unusual case of penetrating ocular injury due to a feather shuttlecock and its surgical management.

Musculoskeletal injuries in real tennis

Introduction: Real tennis is a growing, unique, and well-established sport. To date, there has been no epidemiological data on real tennis injuries. The primary aim of this retrospective study is to record the incidence and document any trends in real tennis musculoskeletal injuries, so as to improve injury awareness of common and possibly preventable injuries.

Methods: A surveillance questionnaire e-mailed to 2,036 Tennis & Rackets Association members to retrospectively capture injuries sustained by amateur and professional real tennis players over their playing careers.

Results: A total of 485 (438 males and 47 females) questionnaires were fully completed over 4 weeks. A total of 662 musculoskeletal injuries were recorded with a mean of 1.4 injuries per player (range 0–7). The incidence of sustaining an acute real tennis musculoskeletal injury is 0.4/1000 hrs. The three main anatomical locations reported injured were elbow 15.6% (103/662), knee 11.6% (77/662), and face 10.0% (66/662). The most common structures reported injured were muscle 24% (161/661), tendon 23.4% (155/661), ligament 7.0% (46/661), soft tissue bruising 6.5% (43/661), and eye 6.2% (41/661). The majority of the upper limb injuries were gradual onset (64.7%, 143/221), and the lower limb injuries were sudden onset (72.0%, 188/261).

Conclusion: This study uniquely provides valuable preliminary data on the incidence and patterns of musculoskeletal injuries in real tennis players. In addition, it highlights a number of reported eye injuries. The study is also a benchmark for future prospective studies on academy and professional real tennis players.

Ocular sports injuries: the current picture

OBJECTIVES

To determine the recent incidence of eye injury due to sport in Scotland, identify any trend, and establish which sports are responsible for most injury? The type of injury and final visual outcome is also evaluated.

METHODS

A prospective observational study of ocular injuries sustained during sport was performed over a one year period. Only patients requiring hospital admission were included. Data were collected on a standardised proforma and entered into a central database. Patients were followed up for at least three months.

RESULTS

Of 416 patients admitted because of ocular injury, 52 (12.5%) resulted from playing a sport. Although all racquet sports together accounted for 47.5% of these injuries, football was the single most common sport associated with ocular trauma, being responsible for 32.5% of cases. The most common clinical finding was macroscopic hyphaema occurring in 87.5% of patients. Overall the final visual acuity was 6/6 in 92.5% of patients.

CONCLUSIONS

The incidence of eye injury due to sport at 12.5% is lower than previously reported, suggesting a change in the pattern of ocular trauma. Football is the single most common cause of ocular injury from sport in Scotland, but the wearing of protective headgear would be difficult to instigate. The incidence of hyphaema in sport related ocular trauma (87.5%) is almost double that of all ocular injury (47.8%), so the potential for serious visual loss as the result of a sports injury should not be underrated. Ophthalmologists have a role in protecting this young population at risk by actively encouraging the design and use of protective eyewear.

Eye injuries in sports

In a retrospective study from 1988 to 1998, eye injuries were found in 553 patients. Seventy-six (13.7%) of these injuries were associated with sport. The mechanism of trauma was for the most part a ball (71.1%) or a club (13.2%). Most eye injuries occurred in soccer (35.5%), which is, by far, the most widespread sport in this region of Norway. A disproportionately high number of the injuries occurred in floorball (17.1%), bandy (13.2%), and squash (10.5%). The rules in these sports may, in theory, be strict enough to prevent eye injuries in most cases. However, these rules are often neglected in informal activities. Strategies for educating the general public about the potentially serious effect of eye injuries in sports exposed to such risk are of great importance.

What do adult squash players think about protective eyewear?

OBJECTIVE

To determine the attitudes of adult squash players towards protective eyewear.

METHODS

A survey of 197 competition and social squash players from seven squash centres in the outer eastern suburbs of Melbourne, Australia was conducted in September to October 1995. Information about participation in squash, previous injuries, use of protective eyewear, barriers towards eyewear use, and attitudes towards protective eyewear was obtained by a self report questionnaire.

RESULTS

Squash is a popular sport in Australia. Of the players surveyed, 6% played in junior competitions, 67% in senior competitions, and 27% were social players. Most had been playing for more than ten years. Some 15% of players had previously suffered an eye injury, most commonly caused by a racquet. Less than 10% of players reported that they wore protective eyewear when they played squash, and 35% of these wore prescriptive lenses which they considered to be protective. The major reason for not wearing protective eyewear was the perception that it was unnecessary. Poor vision and a lack of comfort were also stated as reasons by a significant number of players. More than half (57%) of the respondents agreed that more players should wear protective eyewear, yet only 16% thought it should be compulsory for all players. There was considerable support for protective eyewear use by junior players, however.

CONCLUSIONS

The rate of protective eyewear use is low among competition and social squash players in Melbourne. The major areas that need to be addressed are the ignorance of the need for protective eyewear among social and experienced players and the mistaken belief that prescription lenses provide adequate protection on a squash court.

Can we prevent accidental injury to adolescents? A systematic review of the evidence

OBJECTIVES

As part of the Department of Health strategy The Health of the Nation, a systematic review of published and unpublished literature relating to the effectiveness of interventions in reducing accidental injury in the population aged 15-24 years was carried out.

METHODS

The literature was reviewed under the standard setting headings of road, work, home, and sports and leisure, and graded for quality of evidence and strength of recommendation using a scale published in the UK national epidemiologically based needs assessment programme.

RESULTS

The most effective measures appear to be legislative and regulatory controls in road, sport, and workplace settings. Environmental engineering measures on the road and in sports have relatively low implementation costs and result in fewer injuries at all ages. There is little evidence that purely educational measures reduced injuries in the short term. Community based approaches may be effective in all age groups, and incentives to encourage safer behaviour hold promise but require further evaluation. The potential of multifactorial approaches seems greater than narrowly based linear approaches.

CONCLUSIONS

Few interventions to reduce injury in adolescents have been rigorously evaluated using good quality randomised controlled trials, and where such evidence is available, fewer have been shown to be definitely worthwhile. Many studies relied on surrogate measures rather than actual injury rates, and substantial issues relating to the efficacy or implementation of preventive measures in adolescent and young adult populations remain unresolved.

Orbital blowout fractures in sport

One-third of orbital blowout fractures are sustained during sport. Soccer is most commonly involved. Though visual acuity recovery is usually complete, permanent loss of binocular visual field is almost universal. Typically high-energy blows by opponent's finger, fist, elbow, knee or boot are responsible. Injuries to the eye itself may also be sustained and should be looked for. Ocular protection may be feasible in some sports, but the main preventive measure to be addressed is the reduction in aggressive play or deliberate injury.

Sports-related eye injuries

OBJECTIVE

To: (i) determine the magnitude and describe the spectrum of sports-related eye injuries; (ii) compare the sporting profile variations within Australia and overseas; and (iii) provide recommendations to help decrease the frequency and severity of eye injuries in sports.

DESIGN AND SETTING

Descriptive study of sports-related eye injuries identified from a cross-sectional survey of ocular trauma treated in an eye hospital during a two-year period from November 1989 to October 1991.

RESULTS

Although sports injuries comprised only 5% of all eye trauma, they accounted for a disproportionately high ocular morbidity, representing 22% of hospital admissions. Most patients were admitted for hyphaema (81%), but there were eight ruptured globes and 20 other cases required surgical repair. For those hospitalised for serious injuries, 19% were legally blind (visual acuity < or = 6/60) and 10% had visual acuity between 6/18 and 6/36 initially, with 29% of patients recording a visual loss in excess of 50% incapacity (< or = 6/18) at three months after injury.

CONCLUSION

Eye injuries were most frequently caused by squash, badminton, Australian Rules football and cricket, a sports profile distinctly different from those of the United States and United Kingdom. That none of the players in may study had worn correct eye protection offers a wide scope for preventing injuries in what should be safe recreational pastimes.

Sports-related facial fractures: a review of 137 patients

One hundred and thirty-seven patients with sports-related facial fractures were reviewed. These made up 16.3% of 839 patients with facial fractures seen at the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, between June 1989 and June 1992. Males made up 93.4% of patients and 89.1% were aged below 35 years. There was an intent to injure in 11%. Australian Rules football was the causative sport in 52.6%, all the injuries being the result of human contact. Orbitozygomatic fractures were the most frequently observed overall (62%) as well as in Australian Football (58.3%). Cricket contributed to 14.6%, the ball being the agent of injury in all but one of the patients. Horse-riding injuries were the most severe. 89.1% of the patients required surgery and hospital stays ranged from 0 to 18 days with an average stay of 4.7 days. Sports activities, although a significant source of enjoyment, are a significant cause of facial fractures with their attendant morbidity.

Traumatic hyphaema: a retrospective study of 314 cases

A retrospective study was made of 314 consecutive cases of traumatic hyphaema in a mixed urban and rural Scottish population. Secondary haemorrhage occurred in 4.1% of cases and was not associated with a worsening of final visual acuity. There were no identifiable risk factors for secondary haemorrhage. Poor visual outcome was in most cases attributable to retinal pathology. The use of antifibrinolytic agents does not appear to be necessary in such a population, and the importance of detecting associated retinal detachment is emphasised.