Injuries to the eye are not uncommon, but they are usually not severe since the globe (eyeball) itself is protected by surrounding bones (orbit) and the eye lids. When assessing the severity of any injury, all three aspects of the eye – the globe, orbit and eye lids – should be inspected. Contusions around the eye usually result from a direct blow which causes bleeding under the skin. If there is any suspicion of a fracture, and/or the athlete experiences blurred vision, double vision, or tunnel vision that does not clear within five minutes, the athlete should be immediately referred to a hospital.

Signs and Symptoms

• Immediate pain and a high degree of anxiety are almost always present.
• The athlete may complain of seeing spots or stars and of a decrease in vision.
• Additional signs of a serious eye injury include abnormal eye movement, inability to look upwards, or inability to track properly.

On-Site Management

Determine if there is a serious injury. If vision is normal, pupils react to light and palpation reveals nothing abnormal, you can assume that nothing serious is wrong.

Ice. In the absence of a serious eye injury, ice can be applied. Use caution and apply only gentle pressure. Do not apply ice directly over the eye. A wet towel should be placed over the eye first, and then the ice. Do not allow the athlete to blow their nose as this might increase the bleeding in the eye.

Note: With a blow to the face or eye, the athlete should always be evaluated and monitored for signs of a possible head injury (i.e. concussion).

On-Field Assessment of an Eye Injury

• Have the athlete sit down.
• Test the vision in both eyes. Cover up one eye and have the athlete read anything that is available. Test each eye separately.
• Inspect the eye. Look at the bone structure, the sclera (white portion), the iris, and the pupil. Note swelling, cuts, bleeding or differences between eyes.
• Test the pupils. Have the athlete focus on a distant object, then shine a light into each pupil. The pupils should constrict (become smaller).
• Check eyeball movement. The eyeball moves in six different directions. Have the athlete follow your finger to see if the eye moves in all directions. Note any double vision.
• Palpate. Carefully check the bone structure around the eyeball. Severe pain may indicate a broken bone.

Return to Activity
If swelling is severe enough to obstruct vision, the athlete should not return to activity and should seek medical attention.

Prevention

• A high percentage (90% or more) of eye injuries can be prevented by using proper protective eyewear and other safety precautions.
• Become familiar with current guidelines and equipment designed to prevent eye injuries. Remember that contact lenses offer no protection against eye injury and that athletes who wear contact lenses still require protection.

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