Eye sports injuries, despite lower incidence, possess great impact in athlete’s performance and might shutdown athletes from the competition. This article aims to review eye injuries published in indexed literature related to sports that will be presented at the Summer Olympics Games-Rio 2016.

Methods: A critical literature review of articles was performed. Study analysis was conducted using online databases-Pubmed and BVS-selecting case reports, series of cases and reviews related to eye injuries in sports of which were only selected information’s about the sports practiced on Olympic Summer Games-Rio 2016 with no language restriction, published in a twenty years period (1996 -2016). Other sports that were not in the list of the Olympic Summer Games-Rio 2016 as the modalities practiced only in Winter Olympic Games were excluded from the study. The keywords used were ‘athletic eye injuries’, ‘open globe trauma in sports’, ‘ocular trauma’, ‘ophthalmologic injuries’, ‘eye trauma’, ‘trauma in Olympic games’ and ‘eye injuries’.

Results: USA and England published most of the articles. Corneal abrasion/ulcer and conjunctival hemorrhage were the most frequent injuries reported. Boxing was responsible for the most devastating ocular trauma cases.

Conclusion: The review of indexed literature showed about 970 eyes with sports-related ocular traumas varying from mild to severe in accordance with the 39 sports practiced on the Olympic Summer Games in 2016. Ophthalmologist should be aware of most dangerous sports and type of lesion caused to better inform patients.

Keywords: athletic eye injuries, open globe trauma in sports, ocular trauma, ophthalmologic injuries, eye trauma, trauma in olympic games, eye injuries

Bad, badminton; Bas, basketball; Box, boxing; Cyc, cycling; Gol, golf; Hoc, hockey; Rug, rugby, Soc, soccer; Swi, swimming; Ten, tennis; Vol, volleyball; Wat, water polo

In this year, Brazil will host one of the biggest sports events worldwide: Summer Olympics-Rio 2016 in which will be played 39 modalities (Athletics, badminton, basketball, boxing, canoeing slalom, speed boating, cycling BMX, road cycling, track cycling, cycling mountain biking, fencing, football, gymnastics, trampoline gymnastics, rhythmic gymnastics, golf, handball, equestrianism, field hockey, judo, weightlifting, Olympic fight, aquatic marathons, synchronized swimming, swimming, modern pentathlon, water polo, rowing, rugby, taekwondo, ornamental jumps, archery, shooting sport, triathlon, tennis, table tennis, sailing, volleyball and beach volleyball) and among them 18 have reports of eye trauma in indexed literature.¹

Eye sports injuries, despite lower incidence, possess great impact in athlete’s performance and might shutdown athletes from the competition.^2–5 During Beijing Summer Olympic Games in 2008, 135 athletes suffered eye injuries, representing approximately 4% of all injuries reports.^1,6 According to the International Federation of Sports Medicine (FIMS) modalities are classified in low, high and very high risk to eye injuries.^7,8 The “low risk” sports are those that do not involve infighting, blunt throwing balls and discs or use bats and very accelerate strokes such as athletics, swimming, gymnastics and rowing. Floorball, tennis, squash, badminton, handball, baseball, basketball, volleyball and football (soccer) are considered “high risk” owing to their total or partial ratio with blunt throwing balls, use of bats or aggressive contact. Finally, the “very high” risk sports are: boxing and karate.⁷ This article aims to review eye injuries related to sports that will be presented at the Summer Olympics Games-Rio 2016.

A critical literature review of articles was performed. Study analysis was conducted using online databases-Pubmed and BVS-selecting case reports, series of cases and reviews related to eye injuries in sports of which were only selected information’s about the sports practiced on Olympic Summer Games-Rio 2016, with no language restriction, published in a twenty years period (1996-2016). Other sports that were not in the list of the Olympic Summer Games-Rio 2016 as modalities practiced only in Winter Olympic Games were excluded from the study. The keywords used were ‘athletic eye injuries’, ‘open globe trauma in sports’, ‘ocular trauma’, ‘ophthalmologic injuries’, ‘eye trauma’, ‘trauma in Olympic games’ and ‘eye injuries’.

The number of patients with eye injuries associated to sports that were practiced on Rio Olympic Summer Games in different countries was analyzed. USA and England published 7 and 5 reviews, respectively. Canada, China and Turkey published 2 articles each, followed by Brazil, Finland, France, Italy, Israel, Japan, Korea and Scotland with only 1 each. There were studies from 1976-2016; however, the majority was performed between 2000-2009.

There are few reports mentioning eye injuries during Olympic Games. The biggest one is about the Olympics with the venue being Beijing in 2008 in which athletes population represented almost 15% of all the medical encounters with 5,7% of eye injuries diagnosis. From what concerns London Olympic Games, there were no reports about eye injuries on the literature.⁶ In terms of sports modalities, four articles were found considering swimming, gymnastics and cycling, denominated low risk sports.^2,8–11 Twenty three articles mentioned injuries related to high risk sports as floorball (hockey), badminton, handball, basketball, golf, rugby, volleyball, water polo and soccer.^2,5,6,8–28 Considering “very high-risk” sports category, four articles had registers about boxing among which one described an isolated eyelid traumatic laceration related to karate.^29–34

Figure 1 shows the main causes of eye injuries according to sports modalities. In sports using ball like soccer, badminton, floorball, tennis, golf, volleyball and water polo most injuries were caused by the ball or shuttlecock (51,1% of all eye injuries). However, basketball and rugby had injuries predominantly caused by body contact due to extreme contact between the competitors. Body contact is also present in swimming and boxing, representing 32,08% of sport-related ocular traumas and in a lesser extent, in sports such as soccer and floorball. In cycling, the only cause notified was the handlebars or brakes³³ and in the case of tennis, the ball was a 100% responsible for the injuries. Finally, sports equipment such as bats and rackets motivated 8,16% of lesions and falls were responsible for just 0,12% of all.

Figure 1 Causes of ocular trauma related to each modality.

Table 1 shows the quantity of eye injuries in accordance with each sport, totalizing 970 in all of them. Basketball was responsible for 58 of the injuries, with cases of eyelid lacerations (30) and black eye (17), but also corneal abrasion and rupture with 7 and 3, respectively and one case of optic nerve avulsion. Badminton has 51 lesions of which 13 were hyphema and 7 contusions followed by traumatic uveitis (4), corneal abrasion (3) and glaucoma (3) besides angle resection (2), vitreous hemorrhage (2), choroidal rupture (1), conjunctival congestion, corneoscleral perforation (1), corneal stromal edema (1), macular edema (1), optic atrophy (1), periorbital injury (3), retinal detachment (1), retinal tears (1), subluxation of lens (1), traumatic cataract (1), upper lid edema (1) and uveal prolapse (1).

Considering boxing whose body impact was responsible for the largest number of injuries, studies has shown reports of corneal ulcer, conjunctival hemorrhage or laceration, lens dislocation, optic disc swelling and microcystoid degeneration as the most common represented . With a total of 595 injuries, studies has shown, in a lesser proportion, cases of retinal detachment (8), vitritis (6), corpusculated (5), pigment scar and atrophic retina hole (1) and retinal tears (1). Golf injuries had notifications in 34 eyes, being hyphema the most prevalent (15), followed by commotio retinae (5), lens subluxation (5), choroidal rupture (4) besides one case each of corneal abrasion, orbital wall fractures, periorbital injury, tear detachment and traumatic optic neuropathy. Besides that hockey/floorball resulted in contusions (44), corneal abrasion (2), hyphema (1), orbital trauma (1) and periorbital injury (1), resulting in 49 injuries. Football was the second leading cause of eye sport related trauma, responsible for 131 injuries. The majority resulted in corneal abrasion (44), periorbital injury (19), hyphema (15) and retinal edema (10). However, other types are included as conjunctival hemorrhage (7), diffuse blunt trauma (7), commotio retinae (5), traumatic macular hole (4), and retinal (2) and tear detachment (2), retinal tears (2), choroidal rupture (1), upper lid edema (1) and vitreous hemorrhage (1).

In accordance with this review taking in account those articles based on the 39 sports practiced in Summer Olympic Games-Rio 2016, the most incident sports related to eye injuries are boxing and soccer. The higher incidence of soccer is due to the fact that this sport is the most practiced in the world, and not because of the dangerousness.⁵ On the other hand, boxing has also an elevated prevalence of ocular trauma even with all changes that happened in this sport all over the years as the gloves material variation, their increase in weight and the fights shorter duration. In this way, it has a possible association with stroke’s violence.¹⁹

Corneal ulcer/abrasion and Conjunctival hemorrhage/laceration accounted are four of the most common eye injuries reported, counting with a totality of 371 injury cases of all 970 injuries, comprising approximately 38% of ocular traumas. Meanwhile, corneal ulcer was founded in a hundred percent of the cases of boxing trauma, requiring a higher attention for this pathology in this modality. Conjunctival hemorrhage and laceration are focus in sports as rugby, soccer, swimming, tennis and boxing. High-risk sports (tennis, badminton and floorball/hockey) should stick their concerns about contusions. In turn, corneal abrasion should be more worrisome in cases of badminton, basketball, floorball, golf, soccer, swimming and tennis. Optic disc swelling and lens dislocation were related in it’s entirely with boxing and golf.

The emphasis on needs of using mandated protective eyewear (MPE) is due to the fact that in several studies the predominance of the injuries was in the group without proper protection.^{3,10,11,13,15} Ultimately, demonstrated that the use of correct eye protection could reduce or even eliminate unnecessary traumas that are easily preventable.^{2,5,7,12-15,19,22,24,29} The majority eye-trauma reports came from USA and England probably because of the great coverage of their data center and patient’s information systems although those found in English articles are not specific reports. Taking all in consideration, it cannot be forgotten that people practice sports worldwide, and accidents do not stop to happen. Therefore, this article brings information focused in Olympic modalities helping ophthalmologists to be aware of the most common eye injuries and advertise patients to wear protective eyewear.

Barbara AP Aoto, University Anhembi Morumbi, Lucas V Jorge, University Anhembi Morumbi, Caroline A Ferraz, University Anhembi Morumbi.

None.

The authors declare there is no conflict of interests.

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