Related Terms

• AAFP, AAO, AAP, American Academy of Family Physicians, American Academy of Ophthalmology, American Academy of Pediatrics, American National Standards Institute, American Society of Ocular Trauma, American Society of Testing and Materials, ANSI, anterior chamber, ASOT, ASTM, blunt impact, cataract, Coalition to Prevention Sports Eye Injuries, conjunctiva, cornea, CPSEI, eye guards, eyeguards, face guards, face shields, faceguards, goggles, HECC, helmets, iris, lens, masks, National Eye Institute, National Operating Committee on Standards for Athletic Equipment, National Safety Council, NEI, NOCSAE, NSC, optic neuritis, pupil.

Background

• Overview: Eye protection is the prevention of eye injury through the use of protective equipment and safe practices. The appropriate eye equipment differs depending on the sport. Eye safety may also differ for age groups. Protective eye equipment is relatively inexpensive and its use greatly reduces the risk of eye injuries in high-risk sports.

• Safety equipment: The most common eye protection equipment for sports is eyeguards, face masks, face shields attached to helmets, or a combination of the three. Guards are usually made of durable, transparent materials that offer adequate protection without obscuring vision. Shields and guards are often made of polycarbonate material.

• Eyeguards have a similar design to swimming goggles, motorcycle goggles, and eyeglasses. The first swimming goggles were worn by Persian divers in the 1300s. They were also used in the 1500s by people living along the Mediterranean Sea. It was the Polynesians who took wood-carved diving goggles and added glass lenses. In 1916, the first goggles (although possibly not for swimming) were patented by C. P. Troppman. Swimming goggles gained popularity in the 1930s but did not become commonly used until the 1970s.

• Eye protection is commonly used for sports with a high risk of eye injuries. For adults, these sports include boxing, basketball, baseball, hockey, lacrosse, racquet sports (tennis, racquetball), martial arts, and soccer, according to the American Academy of Ophthalmology (AAO). High-risk sports for children 14 years and younger include squash, softball, baseball, basketball, boxing, racquetball, hockey, and paintball, according to the National Eye Institute.

• According to the AAO, most sports-related injuries (90%) are preventable when the appropriate eye protection is used.

• Every year, there are more than 40,000 sports-related eye injuries, according to the American Academy of Family Physicians (AAFP). More eye injuries happen during racquet sports, baseball, and basketball regardless of age, according to the AAO.

• Baseball causes more eye injuries in children 14 years old and younger than any other sport. In the United States, 4.8 million children (5-14 years old) play baseball every year, making it one of the most popular sports, according to the American Academy of Pediatrics (AAP). Most eye injuries happen when batters are hit by pitched balls.

• Several organizations set standards for eye protection equipment. They include the American Society of Testing and Materials (ASTM), the Hockey Equipment Certification Council, National Operating Committee on Standards for Athletic Equipment (NOCSAE), and the American National Standards Institute.

• Safe practices: Eye protection also involves safe practices. These practices include: (1) choosing the appropriate equipment for the activity and age of the participant, (2) being aware of what activities place the participant at high risk for eye injury, (3) wearing contacts or corrective lenses to improve vision if necessary, and (4) having adequate protection from projectiles, debris, and glare from the sun.

• Government agencies, nonprofit organizations, and experts in the field agree that most sports-related eye injuries are preventable with the use of appropriate equipment and practices. The AAO, AAFP, AAP, National Eye Institute, Coalition to Prevent Sports Eye Injuries, American Society of Ocular Trauma, National Safety Council, and Prevent Blindness America agree that wearing appropriate eye protection drastically reduces the risk of sports-related eye injuries.

Technique

• General: Effective sports-related eye protection involves choosing the most appropriate safety equipment and practices to prevent eye injury for the activity. Recommendations differ depending on the sport.

• Before playing:

• Risk factors: Participants in some sports have a higher risk for eye injuries than others. It is important to understand how different sports are classified in terms of risk. High-contact sports and sports that use equipment, such as balls, sticks, and racquets, have a higher risk of eye injuries than other sports, such as gymnastics and swimming (swimmers typically wear goggles not to protect their eyes from injury but to improve their vision underwater). Several organizations offer information on eye injury risk classification, including the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the National Eye Institute.

• Doctor's visit: The AAFP recommends consulting a doctor before joining a sports team. The doctor may determine if the patient is at risk for eye injuries. If the patient has a family or personal history of eye problems, the doctor may refer the patient to an eye specialist.

• Ophthalmologist: A medical doctor who specializes in eye care is an ophthalmologist. A doctor may refer a patient who is interested in playing high-risk sports to an ophthalmologist for a more detailed eye examination. The ophthalmologist may take a detailed medical history, looking specifically at the family or personal history of eye problems. People who were born prematurely may develop problems with their retinas, or the patient may have other risk factors for eye problems. The doctor may test visual acuity (how well one sees), eye muscle control, and peripheral and color vision. The doctor may also examine the eye's interior (retina, cornea, and iris) with instruments.

• Doctor's recommendations: Depending on the results of the eye exam and medical history, the doctor may make certain recommendations regarding playing high-risk sports. If the patient has eye problems or is at risk for an eye injury, the doctor may encourage the patient to wear protective equipment, practice certain safety measures during play, or abstain from playing that sport.

• Choosing eye protection:

• General: A doctor, coach, or organization (such as the National Eye Institute) may make recommendations about the proper eye protection equipment a player should wear for the sport being considered. Most organizations recommend that players of high-risk sports always wear eye protection. Sunglasses and prescription glasses are not effective protective equipment. In fact, glasses may break during play and cause injury. The American Society of Testing and Materials (ASTM) has set official quality standards for equipment such as eye protectors.

• Proper equipment: Using the proper equipment for the sport reduces the overall risk of injury. Helmet design varies among sports. Hockey helmets, for example, may have extensive faceguards, whereas baseball helmets may not. Talking to a coach about what equipment is appropriate may reduce the risk of injury. All equipment should be certified by a regulating organization like the National Operating Committee on Standards for Athletic Equipment (NOCSAE) or the ASTM.

• Eyeguards: Eyeguards are specially designed sports goggles that serve as a first line of defense against eye injury. First made for racquet sports, eyeguards are now recommended for other sports, such as basketball. A doctor may fit a patient for the appropriate eyeguards. Eyeguards with lenses offer more protection than those without lenses. According to the AAFP, lenses are made of three-millimeter polycarbonate, which is stronger than plastic. Padding at the nose and brow line prevents the eyeguards from damaging skin. They may have additional features, like antifogging, UV protection, tinted coatings for lenses, or side ventilation. For people with impaired vision who wear eyeglasses, the AAFP highly recommends fitting eyeguards with the appropriate corrective lenses. These lenses may be prescribed by an optician or an ophthalmologist.

• Helmets and face masks: In some sports like baseball, a helmet may be worn for added head protection. Most sports helmets, though, do not extend over the face and therefore provide no eye protection.

• Types: Some helmets have wire cages called faceguards that cover part of the face. For added protection, helmets may be equipped with a sheet of polycarbonate, instead of, or in addition to, a cage. This polycarbonate sheet is often called a face shield. Face masks are helmets that completely cover the head and face and are usually made from wire cages or polycarbonate sheets.

• Recommendations: Prevent Blindness America offers specific helmet recommendations for different sports. It recommends wearing eyeguards with the appropriate helmet during all high-risk sports. Recommendations include polycarbonate sheets that cover the eyes attached to baseball and football helmets and hockey masks made of polycarbonate or wire.

• Safe practices:

• General: Safe practices before and during play may reduce the risk of eye injuries. These may include behavioral modifications, education, preparation, proper training and certification, adjustments for different age groups or disabilities, and maintenance of equipment and playing surfaces.

• Maintenance: According to the Nemours Foundation, maintenance of playing surfaces and equipment is an important safety measure. Holes in a field or outdated helmets may cause injury or fail to prevent injury.

• Coaches: A "play-through-the-pain" mentality may worsen injuries. Stopping play when a player is injured and responding quickly and appropriately are important safety practices. Ideally, it is suggested that coaches be cardiopulmonary resuscitation (CPR) certified and knowledgeable about common sports injuries and their prevention.

• Preparation/age appropriateness: Most sports require practice to achieve proficiency and prevent injuries. Developing the appropriate skills during training ensures continued success in competition. These skills, though, should be age-appropriate, according to the American Academy of Pediatrics. Head-first sliding in baseball, for example, is not advised for children younger than 10 years old. Younger children are less coordinated and slower to react than older children and adults. Warming up muscles before play and keeping the body hydrated also prevent injuries.

• One-eyed athletes: One-eyed athletes who have 20/20 vision in one eye and less than 20/40 vision in the other eye are at increased risk for eye injury (corrective lenses cannot improve vision to 20/20). Impaired vision may come from a preexisting condition or be a result of injury. In either case, the player should wear eyeguards and other appropriate eye protection at all times during play, according to the AAFP. If one-eyed athletes experience an injury in their good eye, their vision may be seriously impaired, or blindness may occur. Therefore, these athletes should always wear the recommended eye protection during sports with eye injury risk and should not participate in sports with a very high risk of eye injury, such as boxing, according to the AAFP.

Theory/Evidence

• General: According to the National Eye Institute and several nonprofit corporations, sports may carry a greater or lesser risk of eye injury depending on sports equipment and practices. Classifications of injury risk vary slightly among organizations. The American Academy of Family Physicians (AAFP) divides sports into very high-risk, high-risk, and low-risk. The American Academy of Pediatrics (AAP), American Academy of Ophthalmology (AAO), and National Eye Institute divide sports into high-, moderate-, and low-risk categories. Prevent Blindness America deems sports with any risk of injury as warranting eye protection.

• Very high-risk sports:

• General: According to the AAFP, a very high risk for eye injuries is associated with sports that typically do not use eye protection. Participants in such sports rely on safety measures for protection.

• Boxing: Boxers do not wear eye protection during training or competition. (Boxers may wear protective head gear during practice, but this gear typically offers no eye protection.) Potential eye injuries for boxers include cuts (lacerations), scratches to parts of the eyeball or eyelid, and injuries sustained from blunt trauma.

• Injury prevention: Boxers may wear cushioned head gear during practice to reduce the impact of each blow or prevent trauma. This type of head gear contains no face shield or other equipment and therefore does not prevent blunt trauma to the eyes. Thumbless gloves, though, may reduce the risk of causing eye injuries during practice or competition, according to the American Academy of Ophthalmology. When the thumb is not immobilized, it is more likely to gouge the eye during a punch or jab.

• Wrestling: Like boxers, wrestlers do not wear eye protection during practice or competition. Wrestlers may sustain penetrating eye injuries, although these injuries are uncommon, according to the AAFP.

• Contact martial arts: Tae kwon do, aikido, and karate are examples of martial arts that may carry eye injury risk. Not all activities practiced by martial artists, however, carry a high risk for eye injury. Activities that require contact, such as practice fighting or fighting during competition carry a very high risk of injury. Blunt trauma or penetrating eye injuries may occur from blows to the head.

• High-risk sports:

• General: Some sports use certain equipment or practices that increase the risk of eye injury. Balls, sticks, racquets, and other equipment increase injury risk. Physical contact with other players also increases risk.

• Baseball/softball: According to the AAFP, baseball causes the most sports-related eye injuries. Baseball causes more eye injuries in children younger than 14 years of age than any other sport, according to the National Eye Institute. Although data on softball or tee ball injuries may not be available, the AAP states that the injury risks and recommendations are the same for these sports as baseball.

• Getting hit with a ball or bat and sliding for a base are potential sources of eye injuries. The harder the ball is hit, the more serious the injury may be. According to Prevent Blindness America, injuries to the retina, cornea, iris, and anterior chamber of the eyeball are possible. Cataract (clouding of the lens) is also a potential injury.

• Polycarbonate faceguards attached to baseball helmets and eyeguards prevent eye injuries. These protective measures are supported by the AAP, the AAFP, and the National Eye Institute. Low-impact baseballs and softballs may prevent injury, especially in children 5-14 years old. Avoiding head-first sliding may prevent eye injury, especially in children (children typically have less body control and coordination than adults.)

• Basketball: Basketball is a high-contact sport, which increases the risk for eye injury. Getting hit with a ball is also a potential source of eye injury. According to the National Eye Institute, basketball players 15-24 years old have more eye injuries than players from other sports. One of every 10 basketball players will receive an eye injury, according to the National Eye Institute. Almost all professional (National Basketball Association) basketball players who received eye injuries were not wearing protective gear.

• According to Prevent Blindness America, possible injuries related to basketball include trauma to the retina, iris, anterior chamber, and cornea. Fractures of the orbital bone are also possible. Blunt impact, abrasion, laceration, and penetration of the eye may happen during play. Wearing eyeguards protects against eye injuries.

• Racquet sports: Racquet sports include tennis, racquetball, and squash. Racquetball and tennis-related eye injuries usually require hospitalization or additional treatment. Eye injuries from racquet sports may be especially severe due to the high speed of the ball. The National Eye Institute categorizes tennis as carrying a moderate risk for eye injury for children age 14 and younger (this is the same as the American Academy of Family Physicians' high-risk classification). Eyeguards worn during racquet sports prevent eye injuries, according to the National Eye Institute.

• Football: Orbital (eye bone) fractures are potential football-related eye injuries. Twenty-nine professional (National Football League) football players had orbital fractures between the years 1980 and 1997, according to the National Eye Institute. According to Prevent Blindness America, the cornea, iris, anterior chamber, and retina are potential sites of injury. Eyeguards and faceguards with polycarbonate shields are recommended to prevent eye injuries. The National Eye Institute categorizes football as carrying a moderate risk for eye injury for children age 14 and younger (this is the same as the American Academy of Family Physicians' high-risk classification).

• Soccer: According to the National Eye Institute, one in every 50 soccer players with careers lasting eight years or longer will have an eye injury. Young players and females may be more likely to have eye injuries. Soccer-related eye injuries include damage to the iris, anterior chamber, and the retina. Eyeguards prevent eye injuries in soccer players, according to Prevent Blindness America.

• Hockey: The combination of high contact and equipment (puck and sticks) makes hockey a high-risk sport for eye injuries. Hockey players, with the exception of goalies, typically do not wear eye protection. As of 2007, the National Collegiate Athletic Association (NCAA) allowed field hockey players to wear eye protection during games. Ice and field hockey-related eye injuries to the retina, lens, anterior chamber, iris, and cornea are prevented by eyeguards and masks made out of polycarbonate or wire.

• Other high-risk sports: Fishing, lacrosse, fencing, paintball, and water polo carry a high risk for eye injury. According to the American Academy of Family Physicians, fishing hooks may become lodged in the eye, causing a penetrating injury. Lacrosse, fencing, and water polo players are at risk of eye injuries similar to those in racquet sports. The use of eyeguards may prevent injuries. The National Eye Institute categorizes fishing as carrying a moderate risk for eye injury for children age 14 and younger (this is the same as the American Academy of Family Physicians' high-risk classification).

Safety

• General: Inappropriate or inadequate eye protection may lead to moderate-to-severe eye injury. The severity of eye injuries depends on many factors, including the type of object and force with which it is delivered. Most sports-related eye injuries are caused by blunt trauma, according to Children's Hospital Boston.

• Eye injuries:

• Overview: Injuries to parts of the eye or the surrounding tissue range from minor to very serious. Injuries may be caused by blunt impact, penetration, abrasions, or lacerations. Minor eye injuries may heal naturally and may not require medical attention. In very serious cases, when an object penetrates or lacerates the eye, multiple parts of the eye may become damaged. In these cases, vision loss may be severe and permanent.

• Cornea: The cornea is the clear layer that covers the eye. Scratches to the cornea, also called corneal abrasions, are preventable sports-related injuries, according to Prevent Blindness America. Abrasions occur when a foreign object comes into contact with the cornea. The injury may be minor and heal naturally or require treatment. Corneal abrasions may cause pain, infection, irritation, redness, swelling of the surrounding tissue, impaired vision, or light sensitivity. If the foreign object is located in the eye, a qualified medical professional will need to remove it and treat the area for possible infection. Treatment may involve topical antibiotics, pupil dilation, pain medications, or eye patches. With treatment, scratches to the cornea may heal in a few days.

• Iris: The iris is the part of the eye that controls when and how much the eye dilates. Injuries to the iris range from mild to very severe, depending on the type and force of the injury. Blunt impact may cause inflammation of the iris, also called iritis. A person with iritis may experience pain, light sensitivity, redness, vision loss, or irritation. Treatment may involve pain medications and pupil dilation. Tearing of the iris is a serious injury that may be caused by severe blunt impact. It requires immediate medical treatment by a qualified medical professional.

• Retina: The retina lines the back of the eye. According to Prevent Blindness America, a swollen retina is a preventable sports-related eye injury. A swollen retina may be the result of blunt impact that causes hemorrhaging. It may go away on its own in several days or weeks. A more serious retinal injury is retinal detachment, when part or all of retina detaches from the eyeball. This may cause vision loss, light flashes, or floaters (floating dark spots in vision). Detachment may become more severe without treatment. If retinal detachment is suspected, a qualified medical professional such as an ophthalmologist is required. Treatment may involve surgery.

• Anterior chamber: Injuries to the space that exists between the iris and the cornea (the eye's anterior chamber) may occur as a result of playing baseball, basketball, soccer, football, hockey, or other sports, according to Prevent Blindness America. Blunt impact to the eye may cause bleeding in the anterior chamber, which is called hyphema. Hyphema may be a serious injury that results in loss of vision, buildup of eye pressure, and inability to look at bright light. If hyphema is suspected, medical attention is needed. Treatment may involve bed rest, anti-inflammatory medications, and eye patches. Hyphema may increase the risk for glaucoma later in life.

• Conjunctiva: The conjunctiva is a thin coating of surface tissue on the eyeball, which contains blood vessels. Blunt impact may cause a hemorrhage or breakage of these vessels. Blood may spill out into the conjunctiva, turning the eyeball red in color. It usually goes away without treatment in several days or weeks.

• External areas: Injuries to the tissue surrounding the eyes or tear ducts may be caused by blunt impact or cutting.

• Black eye: Blunt impact to the eye area may cause injury to the skin and tissue surrounding the eye. This may cause a black eye, which is formed by the collection of blood in the lower eyelid. Bruising, swelling, and skin discoloration may follow. Black eyes may not require medical treatment and may heal in a few days or weeks, depending on the extent of the bruising. Medications such as aspirin and alternating warm and cold compresses may reduce swelling and pain. On their own, black eyes may not be very serious injuries or negatively impact vision, but they may be accompanied by more serious injuries.

• Lacerations: A laceration is a jagged wound or cut. Lacerations to the eyelid may remove pieces of tissue and may require stitches. Damage to the tear ducts may also occur. If this type of injury is suspected, medical attention is needed.

• Lens: The lens is the part of the eye that aids in focusing. A cataract occurs when the lens is damaged and becomes cloudy. This may cause vision loss and swelling, which may result in pain. The extent of vision loss depends on cataract location. Treatment may involve contact lenses or eyeglasses to improve vision or drugs to dilate the pupils. Eventually, surgery may be necessary to remove the damaged lens and replace it with an artificial lens. Lens dislocation may be caused by severe blunt impact and is a serious eye injury requiring medical attention by a qualified medial professional.

• Nerves: Injuries to the nerves that connect to the eye may be severe. The retina sends signals to the optic nerve, which in turn transmits the signals to the brain. Damage to the optic nerve may result in vision loss. Damage may be caused by inflammation inside the eyeball, which in turn causes optic neuritis (optic nerve inflammation). Optic neuritis is usually accompanied by vision loss, which may be moderate or very severe. Vision usually recovers on its own, especially if the patient has no prior history of neuritis. Neuritis may also be treated with steroids.

• Bone injuries:

• General: The bone surrounding the eyeball is called the orbit. Orbital injuries may be very serious and require medical attention. They may be accompanied by other eye injuries. Orbital fractures usually are caused by significant force and may occur when a person is hit in the face by a ball or other object.

• Fractures: In a blowout fracture, the bone itself may not be hit. Instead, the eyeball absorbs the force of the projectile, which is transferred to the orbit. Orbital fractures may cause pain, swelling, double vision, pressure, bruising, eyeball trauma, nerve damage, muscular damage, and nasal or sinus damage. A qualified medical professional will usually evaluate the injury using a computed tomography (CT) scan. Treatment may involve surgery if the symptoms persist. Other treatments include pain medications, cold compresses, and nasal sprays to prevent swelling of the sinuses.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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