Preventing Sports-Related Eye Injuries: Protection and First Aid

A squash ball travelling at high speed fits neatly into the eye socket. A basketball player's finger can catch an opponent's eye in a rebound. A paintball fired at close range can rupture the eyeball. Sports-related eye injuries are common, often affect young people and can cause permanent vision loss. Yet eye care organisations such as the American Academy of Ophthalmology estimate that the vast majority, around 90%, could be prevented with appropriate protective eyewear.

This article explains which sports carry the highest risk, what kind of protection actually works, what to do immediately after an eye injury and why a condition called hyphema always needs medical attention.

How sports injure the eyes

Sports eye injuries generally fall into three categories:

• Blunt trauma: a ball, racquet, elbow or fist hits the eye or the bones around it. The eyeball is compressed and then rebounds, which can cause bleeding inside the eye, damage to the iris, lens or retina, retinal detachment and fractures of the thin orbital floor (a blowout fracture). This is the most common type.
• Penetrating injuries: broken glasses, fishing hooks or sharp objects pierce the eye. These are less common in sport but very serious.
• Abrasions and radiation: a finger poke scratching the cornea, or UV damage in water sports and skiing.

The size and speed of the object matter. Objects smaller than the bony rim of the eye socket, such as squash balls, shuttlecocks, golf balls and paintballs, can strike the eye directly instead of being stopped by the bones around it.

High-risk sports

Racquet sports

Squash is notorious for eye injuries because the ball is small, fast and played in an enclosed court, often with players close together. Badminton shuttlecocks can travel extremely quickly and are the right size to hit the eye directly; badminton is a leading cause of sports eye injury in parts of Asia. Tennis and padel balls are larger but still cause injuries, especially at the net. Racquets themselves cause injuries too, especially in doubles.

Ball sports

In many countries, basketball and baseball account for a large share of sports-related eye injuries treated in emergency departments. In basketball, fingers and elbows are the main culprits; in baseball and softball, balls and bats. Cricket, hockey and lacrosse involve hard balls at high speed.

Paintball and airsoft

Paintballs and airsoft pellets can cause devastating injuries, including rupture of the eyeball and loss of the eye. Most serious injuries happen when players remove or lift their masks in play areas or in uncontrolled settings without supervision. Full-face protection meeting the relevant standard must stay on at all times in any area where guns may be fired.

Why ordinary glasses are not enough

Everyday glasses and fashion sunglasses are not designed to withstand sports impact. Glass or standard plastic lenses can shatter, and thin metal frames can bend into the eye, turning a minor blow into a penetrating injury. Even the open-frame "eye guards" without lenses that were once used in squash have been shown to allow balls to deform through the opening and reach the eye.

Contact lens wearers have no protection from the lenses themselves; they still need protective eyewear.

Polycarbonate protection: what to look for

Polycarbonate is an impact-resistant plastic and the standard material for sports eyewear. Trivex is a similar alternative. Lenses made from these materials are much more resistant to shattering than ordinary lenses and also block UV. Our guide to lens materials explains the differences.

Good sports eyewear should:

• Meet a recognised standard for the sport. In the United States, ASTM F803 covers eyewear for many racquet and ball sports; in Europe, EN 166 and sport-specific standards apply. Paintball masks have their own standard (ASTM F1776).
• Use polycarbonate or Trivex lenses, typically at least 3 mm thick at the centre for high-impact sports.
• Have a sturdy frame with a padded nose bridge and a design that keeps the lenses from being pushed into the eye.
• Wrap around to protect from the sides.
• Fit securely, often with an adjustable strap, without slipping during play.
• Be available with prescription lenses for those who need correction.

For more on choosing protective frames and lenses, see our guide to safety and sports eyewear and the broader eye safety at work and in sports guide.

Children and young athletes

Children and teenagers account for a large proportion of sports eye injuries. Their reflexes and hand-eye coordination are still developing, and they often play without supervision or protection. Parents and coaches can help by making protective eyewear a normal part of the kit, just like shin pads or helmets, and by modelling the habit themselves. Children who wear glasses should use prescription sports goggles rather than their everyday glasses. Our guide to eye health in children offers more advice.

First response to blunt eye trauma

Knowing what to do in the first minutes can protect vision. If someone is hit in the eye during sport:

1. Stop play and assess the person calmly.
2. Do not press on the eye or rub it. Do not try to remove an object stuck in the eye.
3. Protect the eye with a rigid shield, such as the bottom of a paper cup taped over the eye socket, resting on the bones around the eye rather than on the eye itself.
4. Apply a cold compress gently to the cheek and brow, not pressing on the eyeball, to reduce swelling if there is no sign of a penetrating injury.
5. Keep the person upright, with the head raised, which can help blood in the eye settle.
6. Avoid giving aspirin or ibuprofen for pain until a doctor has assessed the injury, because these can increase bleeding. Paracetamol is generally preferred, but follow medical advice.
7. Seek medical assessment. Even if the eye looks normal, internal damage may not be obvious.

For a chemical splash, by contrast, the priority is immediate rinsing with clean water for at least 15 minutes. More first-aid scenarios are covered in our eye emergencies and first aid guide.

Hyphema: blood in the front of the eye

A hyphema is a collection of blood in the anterior chamber, the space between the cornea and the iris. It usually results from blunt trauma tearing small blood vessels in the iris or the angle of the eye. A large hyphema is visible as a red layer at the bottom of the coloured part of the eye; a small one may only be seen by an eye doctor with a microscope.

Hyphema matters because:

• It can raise eye pressure, potentially damaging the optic nerve.
• Rebleeding can occur, typically within the first several days, and is often more severe.
• It may stain the cornea with blood if the pressure stays high.
• It signals that the eye has taken significant force, so other damage such as retinal tears, lens dislocation or damage to the drainage angle must be checked. Angle damage can lead to glaucoma years later.
• People with sickle cell disease or trait are at higher risk of complications and need particularly careful management.

Treatment is decided by an eye doctor and often includes rest, keeping the head raised, a protective shield, eye drops to control inflammation and pressure, and close follow-up. Surgery is occasionally needed. Anyone who has had a hyphema should have long-term check-ups for glaucoma.

Other serious injuries to watch for

• Orbital blowout fracture: double vision, especially looking up, numbness of the cheek or upper lip, a sunken eye, and swelling after nose blowing.
• Retinal detachment: new floaters, flashes or a shadow across vision, possibly days to weeks after the injury.
• Corneal abrasion: sharp pain, watering, light sensitivity and a feeling of something in the eye after a finger poke.
• Ruptured globe: severe pain, a misshapen pupil, a deflated-looking eye or fluid leaking; this is an emergency requiring a rigid shield and immediate transfer to hospital.

When to see a doctor

Any significant blow to the eye in sport should be assessed by an eye care professional, even if the person feels fine afterwards. Internal bleeding and retinal tears are not always visible from the outside.

Protective eyewear is cheap compared with the cost of a lifetime of reduced vision. Choose polycarbonate protection for your sport, make it part of the kit for every training session and match, and know what to do if an injury happens.