Sport plays an important role in keeping us active and healthy, but injuries can happen at every level – from weekend football and a game of squash to competitive cricket, rugby and contact sports.
While we commonly associate sporting injuries with muscles, joints and bones, the eyes can also be vulnerable. A ball travelling at speed, an accidental finger or elbow, a racquet, or a collision with another player can cause an eye injury in a fraction of a second.
September is recognised as Sports Eye Safety Month, an annual awareness campaign highlighting sports-related eye injuries and the importance of appropriate eye protection.
As the awareness month draws to a close, Gurjeet Jutley, Consultant Ophthalmic Surgeon, who has undertaken specialist fellowship training in ophthalmic trauma, looks at how sporting injuries can affect the eye, the warning signs that should not be ignored and why the consequences of an injury are not always immediately apparent.
How can sport cause an eye injury?
The risk and nature of an eye injury varies considerably between different sports.
In the UK, familiar activities including football, rugby, tennis and badminton carry a recognised risk of eye injury, while sports involving fast-moving hard objects, sticks or close contact – such as cricket, hockey and squash – can present a higher risk.
The injury itself may result from a direct impact to the eye or the surrounding structures. In football, for example, this could be the ball striking the face at close range or accidental contact with another player’s hand or elbow. In cricket or squash, a relatively small ball can be travelling at considerable speed.
The International Olympic Committee’s consensus on sports ophthalmology recognises that sporting trauma can affect the eyelids, the eye itself and the surrounding orbit. Although many blunt sporting injuries have a good visual outcome, more significant injuries can result in complications requiring specialist assessment, treatment and follow-up.
What happens when the eye is struck?
The eye is a complex and delicate structure. Even when there is no obvious cut or penetrating injury, a forceful impact can transmit considerable energy through the eye.
One possible consequence is a corneal abrasion, where the clear surface at the front of the eye is scratched. Trauma may also cause bleeding into the front of the eye, known as a hyphema, or inflammation within the eye.
A significant impact can affect the natural lens and, in some cases, lead to a traumatic cataract or displacement of the lens.
The retina at the back of the eye can also be affected. Trauma can cause retinal damage and, in more serious circumstances, retinal tears or detachment. Injuries can additionally involve the optic nerve or the bones surrounding the eye.
The type and severity of injury will depend on factors including the object involved, its speed, the direction and force of impact, and the area of the eye that has been struck.
An eye can look normal and still have been injured
One of the important considerations with ocular trauma is that the external appearance of the eye does not necessarily reveal everything that has happened internally.
There may be obvious bruising and swelling after a sporting collision, but some damage occurs within the eye and cannot simply be seen by looking in a mirror.
Likewise, initial discomfort may settle after an injury, leading someone to assume that everything is fine.
This is why changes to vision following significant eye trauma should not be dismissed simply because there is little external evidence of injury.
An ophthalmic assessment can examine structures inside the eye and help determine whether further treatment or monitoring is required.
What symptoms should you look out for?
Following an impact to the eye or surrounding area, particular attention should be paid to changes in vision or the way the eye feels and functions.
Symptoms that can require urgent medical assessment include:
- sudden or reduced vision;
- blurred or double vision;
- severe or persistent eye pain;
- increasing redness or swelling;
- sensitivity to light;
- new flashes or floaters;
- a dark shadow or curtain across part of the vision;
- visible blood in or coming from the eye;
- difficulty opening or moving the eye;
- a change in the shape of the pupil; or
- an object penetrating or becoming embedded in the eye.
A significant deterioration or loss of vision following an injury should be treated as an emergency.
If an object has penetrated the eye, do not attempt to remove it yourself and avoid putting pressure on the eye. Urgent medical attention should be sought.
The effects of trauma can sometimes appear later
An important aspect of ophthalmic trauma is that not every complication necessarily develops at the time of the original injury.
This is particularly relevant to glaucoma.
A significant blunt impact can damage the drainage structures located within the front of the eye. One form of this damage is known as angle recession.
The eye continually produces fluid, which normally drains through structures within this angle. Trauma can alter or damage this drainage system and, in some people, this can subsequently contribute to increased pressure within the eye and the development of secondary glaucoma.
Importantly, traumatic or angle-recession glaucoma may develop months or even years after the original injury.
This illustrates why a history of significant eye trauma can remain clinically relevant long after the bruising, discomfort and other immediate symptoms have disappeared.
Why specialist assessment matters
Following significant ocular trauma, an ophthalmologist may need to assess more than the visible surface of the eye.
Depending on the circumstances, an examination may include assessment of vision, the pupil and eye movements, measurement of the pressure inside the eye and examination of the lens, retina and other internal structures.
The drainage angle of the eye can also be examined where appropriate, particularly when assessing the possible longer-term effects of blunt trauma.
Further imaging or investigations may sometimes be required depending upon the suspected injury.
This is particularly important because ocular trauma can vary considerably. Two injuries that appear similar from the outside may have very different effects on the structures inside the eye.
Can sporting eye injuries be prevented?
It is impossible to remove every risk from sport, nor should concerns about eye injuries discourage people from enjoying physical activity.
However, sensible precautions can reduce the likelihood of some injuries.
Moorfields Eye Hospital advises that appropriately fitted eye protectors can reduce the risk of significant sporting eye injury considerably. Protective eyewear is particularly important for activities carrying a moderate or high risk of eye injury and for people who have previously suffered an eye injury, undergone eye surgery or have useful sight in only one eye.
Sports eye protection should be appropriate for the particular activity, correctly fitted and manufactured from suitable impact-resistant materials.
It is also worth remembering that ordinary prescription spectacles are not necessarily a substitute for dedicated sports eye protection.
What should you do immediately after an eye injury?
The appropriate action will depend on how the injury occurred and its severity.
For a minor impact around the eye, a cold compress may sometimes help reduce swelling, but pressure should not be placed directly onto the eyeball.
Avoid rubbing an injured eye.
If there is significant pain, a change in vision, bleeding, difficulty moving the eye or concern that something may have penetrated the eye, urgent medical attention should be sought rather than attempting to manage the injury yourself.
Chemical injuries require immediate irrigation with plenty of clean water and urgent medical assessment.
Protecting your sight beyond Sports Eye Safety Month
Sports Eye Safety Month provides a useful opportunity to raise awareness, but protecting our eyes should naturally extend beyond September.
The majority of people participate in sport without experiencing a serious eye injury. Nevertheless, understanding the potential risks can help players, parents, coaches and sporting organisations take sensible precautions.
It is equally important to recognise when an injury deserves medical attention.
For Mr Jutley, whose specialist ophthalmic training includes a fellowship in trauma, this is an important part of the message. Eye trauma is not simply about the immediate bruising or discomfort following an accident. An injury can affect different structures within the eye and, in certain circumstances, its consequences may require treatment or monitoring beyond the initial incident.
Being aware of changes to your vision, using appropriate protection where recommended and seeking timely assessment following significant ocular trauma can all play a part in protecting your sight.
Concerned about an eye injury?
Gurjeet Jutley is a Consultant Ophthalmic Surgeon with specialist experience in ophthalmic trauma, alongside expertise in glaucoma and cataract care.
If you have experienced an injury to the eye and are concerned about changes to your vision or its longer-term effects, an ophthalmic assessment can help establish whether the eye has been affected and whether treatment or ongoing monitoring may be required.
Please note: This article is intended to provide general information and does not replace individual medical advice. Sudden loss or significant deterioration of vision, severe eye pain, penetrating injuries, bleeding from the eye or other serious symptoms following trauma require urgent medical attention.