Cupped in the palm of your hand, a racquetball looks harmless enough. Propelled through the air by your racquet, the little blue ball can reach speeds of 100 miles per hour or more and pose serious danger to an unprotected eye.

Racquetball and other sports are directly responsible for about 100,000 eye injuries each year, many severe enough to endanger sight. About 70 percent occur to children and young adults, and nearly all could be prevented with proper safety measures.

Racquetball is a danger not only because of the speed at which the ball is propelled but because the ball is small enough to pass through the boney, protective areas of the face and make direct contact with the eyeball. Blows from any size ball or from a puck, hockey stick, racquet, finger or elbow can also cause serious damage to the eye. And head trauma is a frequent cause of detachment of the retina.

In adults over age 25, eye injuries are common in all the racquet sports plus volleyball and basketball. Children and young adults are most frequently injured playing baseball or basketball–reflecting in part the high popularity of those sports. Football, hockey and boxing also account for many eye injuries.

An object hitting squarely on the eye can rupture the sclera, the outermost layer of the eyeball. It may also cut the eyelid and damage the iris, cornea, vitreous or other structures inside the eye. The retina can be torn or detached either by a direct blow to the eye or trauma to the side of the head.

Hyphema, the medical term for accumulation of blood in the anterior or front chamber of the eye, can result from either blunt or penetrating trauma. Other injuries may occur at the same time, but even the accumulation of blood and pressure is a danger to sight and requires prompt medical attention.

Protecting Your Vision
At least 90 percent of eye injuries can be prevented simply by wearing proper eye protection.

If you’re playing racquetball or squash, you shouldn’t step inside the room without shatterproof safety goggles. Eye protectors without lenses are not safe.
Protective eyewear is also available and recommended for baseball, basketball, football, ice hockey and tennis. Sturdy frames distribute the impact to boney protective areas around the eyes, and most models have rubber padding to cushion the frame. A wrap-around style helps keep wind and dust out of the eye.

Your eyeglass prescription can be built into the lens or you can wear contact lenses under the goggles.

The best material for protective eyewear is polycarbonate, strong enough for use in plastic riot shields and jet airplane canopies. It’s relatively scratch resistant, usually has built-in ultraviolet protection and is at least seven times more resistant to impact than the next best available lens material.

Don’t use any product that has not passed the standards of either the American Society for Testing and Materials (ATSM) or the Canadian Standards Association (CSA), the organizations charged with testing and writing performance standards for protective eyewear.

Sports goggles similar to those recommended for racquet sports have been designed for basketball use. For hockey, a full-face protective device can be mounted to the helmet. The Canadian Amateur Hockey Association started requiring these for amateur players starting in 1981, and, as a result, the incidence of eye injuries declined from 257 in 1974 to none in 1983. Most professional hockey players, unfortunately, do not wear eye protection.

A polycarbonate face protector mounted to a baseball helmet has been endorsed but not mandated by the Little League. Face masks provide some protection for football players, although fingers can still poke through. Full-face protectors are preferred.

One-eyed athletes or those with severely impaired vision in one eye should consider eye protection mandatory. Many doctors advise such persons to refrain from contact sports such as boxing, wrestling and martial arts where proper eye protection is not possible.
Sports-related eye injuries are much more common among children who are not yet physically mature or coordinated enough to protect themselves and may freeze at the sight of a ball heading directly toward the face. A ball thrown even at 45 miles per hour is capable of damaging the eye and the area around it.

Many injuries can be prevented by close adult supervision of sports activities and enforcement of game rules such as the prohibition of above-the-shoulders “sticking” in ice hockey.

Dealing with an Injury
A blunt blow to the eye is likely to cause damage at the front surface and also at the back, as the eye is forced back into the socket.

Cuts to the eyelid may make an injury seem more serious than it is, but any bleeding should not be taken lightly. Don’t attempt first aid at home; call for emergency help. Although an eye can be bandaged lightly as an emergency measure, don’t attempt to wash the eye, apply pressure to it or rub the area.

Traumatic hyphema, involving bleeding within the eye, can lead to permanent vision loss, but if good medical care is delivered promptly, complications can be avoided. Persons with sickle cell trait or disease have a higher risk of complications.

Bleeding within the eye, as well as direct injury, can lead to detachment of the retina. Symptoms include floating shapes, flashes of light and blurred vision.

Even if a person’s eye is knocked out of the socket, vision may be saved if you get the patient to an emergency room promptly. If there’s time before the ambulance arrives, cover with a clean, moist dressing, and cover the other socket as well to prevent eye movement.
The traditional black eye is caused by blood leaking into the skin around the eye and is usually not serious. A cold compress, applied for 5 to 10 minutes at a time, can reduce pain and swelling. To manage pain, use acetaminophen (Tylenol) since aspirin and nonsteroidal antiinflammatory drugs can increase bleeding.

If there is any blurring of vision, any possibility of bleeding within the eye or if you have any question about the seriousness of the injury, seek medical attention promptly.
It’s easy to take for granted your eyesight or that of your child. Injuries that endanger vision usually occur instantaneously and must be dealt with immediately. The better course, by far, is to take simple preventive measures.

REFERENCES:
John P. Difiori, “Sports-Related Traumatic Hyphema,” American Family Physician, September, 1992.
“Eye Injuries,” the Merck Manual of Medical Information–Home Edition.
Carolyn J. Gard, “Eye See,” Current Health 2, January, 1997.
Ralph Laforge, “Preventing Eye Injuries,” Executive Health Report, March, 1990.
“Protective Eyewear for Young Athletes,” a Joint Statement of the American Academy of Pediatrics and American Academy of Ophthalmology.
Gary J. Silko and Paul T. Cullen, “Indoor Racquet Sports Injuries,” American Family Physician, August, 1994.
S.L. Smith, “Eye Safety Beyond the Plant Gate,” Occupational Hazards, January, 1994.
Jonathan G. Stock and F. Michael Cornell, “Prevention of Sports-Related Eye Injury,” American Family Physician, August, 1991.
“Sports Eye Injuries,” Pediatrics for Parents, February, 1998.