You'll Poke Your Eye Out, Kid

According to the American Academy of Ophthalmology, eye injuries are the leading cause of blindness in children. Many of these tragedies are tough to avoid. Running with sticks and pencils remains high on the list of dangers despite years of scolding from parents and teachers. Then there are the toys. BB guns and other shooting devices continue to injure and blind kids. But for many eye care professionals, the one area ripe for change is sports. Here, regulations can safeguard kids against a host of eye dangers.

"Little League is one place we'd really like to see a change," says David Hunter, M.D., assistant professor of pediatric ophthalmology and strabismus at the Johns Hopkins University School of Medicine.

"There are some great helmets available with face shields, but peer pressure keeps them from being used. If shields were required, by law or by the league, peer pressure would no longer be an issue. An interesting footnote to this problem is that when kids wear face shields, their batting improves. This may be because they're no longer scared that the ball is going to hit them."

Approaching safety with smart rules isn't a new idea. Bike helmet laws currently prevent head injuries in many states. Similar head protection holds true for hockey. "There was a time when professional hockey players didn't wear helmets," Dr. Hunter says. "Today we look back at that time as if they were crazy. I hope the day comes when we will look back in disbelief at this time, when we didn't require children to use adequate eye protection."

Injuries

Damage from eye injuries depends largely on the size and speed of the ball. Small balls like those used in racquetball and squash can fit right into the eye socket, bypassing the built-in safety feature of the orbital bones around the eye. "In addition to damaging the eye directly, these hits can push the eye so hard that it fractures bones inside the eye socket," says Dr. Hunter. Muscles that control eye movement can be damaged as well, and even after corrective surgery, scar tissue can develop that impedes smooth movement of the eye. This can lead to double vision. The larger balls used in sports such as baseball and softball can break the bones surrounding the eye.

Prevention

"Anyone who works in ophthalmology sees cases of sports-related eye injuries," says Dr. Hunter. "It's frustrating because they're almost all preventable." He pushes the need for reasonable and realistic eye protection. With children of his own, he knows that achieving a balance between prevention and common sense is what's needed. "You have to be reasonable," he says, "otherwise we'd all walk down the street with helmets and body armor."

What does Dr. Hunter recommend? It depends on the sport and the person. "For people with vision in only one eye we make sure they have sturdy frames and lenses, even for street wear but especially for sports." For those with two good eyes playing less intensive sports, Dr. Hunter suggests sunglasses or sports goggles for those who don't already wear glasses. For competitive ball or stick sports, sturdy sports goggles with polycarbonate lenses are a must. "Basketball, which might seem like a safe sport for the eyes, is actually the leading cause of sports eye injuries. I see lots of weekend basketball players who miss time from work with a painful scratched cornea caused by a finger in the eye." Polycarbonate lenses have proven their strength in studies, but Dr. Hunter points out that the need for sturdy frames is often overlooked. "Safety comes from a combination of the lens and the frame. If you have a polycarbonate lens in a flimsy frame, the lens itself could pop out and cause damage."

Some get lucky

Eye injuries happen in an instant. Just ask Van Browne. When the 20-year-old college student was in eighth grade, he got slammed in the eye with a baseball.

"I was playing second base, and I guess the infielders were not doing so hot that night at practice, so the coach held us after for more practice. I guess the coach was hitting some pretty hard practice balls, and one took a bad hop and hit my eye. It swelled shut for three days, and when I opened it I had double vision."

His doctor referred him to Johns Hopkins where he met pediatric ophthalmologists Michael Repka, M.D., and David Hunter, M.D. "Dr. Repka put me in prism glasses," Browne says. "They're thick glasses that look clear, but actually have lines in them. If a person with normal sight puts them on, he sees double, but for me the glasses lessened the double vision. The doctor started me off with a real strong prescription. Then, every few weeks I'd go in and they'd decrease the strength." He wore the glasses for three months.

Sometimes prism glasses are enough to correct double vision. But it appeared that for Browne that wasn't going to be the case. He was scheduled for corrective eye surgery.

"I didn't get to the point where my vision was back to normal until the day before my surgery," he says. "I woke up and could see fine. But when I put the prism glasses on, my vision went double again. So the next day, the day of the surgery, I got up and could see fine again. But this time I didn't put the glasses on. We went to the hospital and showed them that I could see without the glasses."

Many kids who suffer childhood eye injuries are not as fortunate. Total and partial blindness can often result from injuries similar to his. And of course, eye injuries aren't limited to kids. In fact, the week that Browne was contacted for this story he had a close call with the same eye he had injured as a child.

"I got a black eye playing basketball," Browne says. "I was on the court, holding the eye shut and thinking, 'I hope I can see all right when I open my eye.'" He could. Lucky again.

Last Updated: 9/20/2002
The Johns Hopkins University 1996-2003.  All rights reserved.  This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.