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Eye Injuries in Sports Practice: Mini-Review

As stipulated in the International Charter on Physical Education and Sports, the practice of sports is an entitlement and a duty for each person [1]. In Spain, more than half of the population over 15 years old practiced sports in the last year, 53.5%, either regularly or occasionally [2]. From people who practice weekly, a high percentage play sports with risk of eye injury such as football (12.9%), paddle tennis (7.9%), tennis (4.1%), basketball (4.1%), etc. Therefore, eye injuries in sports are an issue that deserves special attention. The results of the United States Eye Injury Registry (USIER) showed that 13% of the eye injuries were due to recreation or sports; and they were characteristic of young people under 30 and males [3]. Similarly, Cillino et al. [4] found that sport activities were one of the causes of eye injury in men (17.5%), while in women the prevalence was more homerelated or outdoor activities. Most of these injuries are considered preventable [3-5]. The main aim of this mini-review is to describe the common eye injuries depending on the type of sport practiced and to suggest some protections for prevention.


Introduction
As stipulated in the International Charter on Physical Education and Sports, the practice of sports is an entitlement and a duty for each person [1]. In Spain, more than half of the population over 15 years old practiced sports in the last year, 53.5%, either regularly or occasionally [2]. From people who practice weekly, a high percentage play sports with risk of eye injury such as football (12.9%), paddle tennis (7.9%), tennis (4.1%), basketball (4.1%), etc. Therefore, eye injuries in sports are an issue that deserves special attention. The results of the United States Eye Injury Registry (USIER) showed that 13% of the eye injuries were due to recreation or sports; and they were characteristic of young people under 30 and males [3]. Similarly, Cillino et al. [4] found that sport activities were one of the causes of eye injury in men (17.5%), while in women the prevalence was more homerelated or outdoor activities. Most of these injuries are considered preventable [3][4][5]. The main aim of this mini-review is to describe the common eye injuries depending on the type of sport practiced and to suggest some protections for prevention.

Sport classification according to risk of eye injury
If sports are categorized in different groups according to the risk they involve, the low risk category would include sports as swimming, gymnastics, and cycling, which do not imply the use of a ball, puck, bat, stick, or racquet, and no body contact. Conversely, high-risk sports involve the use of a ball, puck, bat, stick, or racquet and/or body contact, such as baseball, hockey, football, basketball, racquet sports, tennis, golf, and water polo. Other sports such as boxing, wrestling, and contact martial arts could be considered very-high-risk sports, because eye protectors normally are not worn [5,6]. According to the study of Ong et al. [7] football was the sport most related to eye injuries with a prevalence of 62.5%, followed by squash (10.4%) and cricket (6.3%). Badminton, rugby and tennis had a lower prevalence around 4%, and below them were baseball (2.1%) and golf (2.1%), among others. 81.2% of the total of injuries were caused by a ball which contacted the eye. The prevalence change from one study to others, but these are the sports which normally cause greater eye trauma. Table 1 shows the variability of prevalence for each sport according to different authors.

Common injuries in sport practice
Generally, the common mechanisms of eye trauma involve blunt, and rarely penetrating and radiation injuries. Blunt trauma can cause from simple alterations to severe affections, including: subconjunctival hemorrhage, orbital and lid contusions, orbital fracture, iris injury, choroidal rupture, ruptured globe, hyphema, retinal hemorrhage, vitreous hemorrhage, retinal tears, and retinal detachment, among others [5,6]. Penetrating injuries can occur with large projectiles or eyeglass breakage. Regarding to radiation injuries, they occur as a result of exposure to ultraviolet light in sports which involve great exposure to sun such as snow or water skiing, and other water sports [5].
Eye injuries caused by football and basketball are closely associated with collision with another player, which can result in an orbital fracture causing a secondary contusion, typically affecting retina. The ball impact can result in a hyphema [8,9]. Vitreous hemorrhage, commotio retinae, retinal tear and retinal detachment, choroidal rupture, macular hole, maculopathy and epiretinal membrane are posterior segment alterations found after traumas in sports which involve a medium or small ball such as tennis, paintball or golf ball [10]. There are also alterations related to anterior segment such as hyphema, cataract, corneal abrasion, edema, subluxated lens, glaucoma, iridodialysis and angle recession [10]. Alterations related to each sport are shown in Table 2.
to the rest of the eye. Sports goggles with polycarbonate lenses are suitable for sports such as basketball, football, tennis, baseball or softball [4,5]. However, in other sports like, field or ice hockey, and paintball the most appropriate option is to use full face protection [3]. In case of outdoor activities which imply high sun exposure it is recommended to use high impact resistant eye protection or sports goggles with polycarbonate lenses as well as an ultraviolet filter [6,[15][16][17]. Protection equipment for different sports is shown in Table 2 [18].

Conclusion
The eye is an irreplaceable organ and sports practice poses a risk to this precious body part that allows us to see the world. Therefore, we recommend using the most appropriate protection in any sport practice for preventing injuries, especially in sports with medium or high risk. Although, high-risk sports involve contact activities for which a ball is usually used such as football, tennis, etc. it is also important to note that eye injuries are not always related to an impact and in some other time an unconscious risk may be present like in those practiced in environments with high radiation such as skiing, climbing, etc. In conclusion, due to the diversity of injuries related to the eye, it is important to investigate those patients who arrive to our offices with a trauma caused while practicing sports, paying attention to the ocular surface, orbital structure and retinal status. Furthermore, it should be recommended that the use of specific eye equipment for each sport in order to avoid traumas as much as possible. Table 2: Mechanisms which cause ocular trauma, common alterations derived from them and protection equipment and strategies to prevent them [5,6,14,19].