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Sports-Related Eye Injuries: Floorball Endangers the Eyes of Young Players

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Sports-Related Eye Injuries: Floorball Endangers the Eyes of Young Players Scand J Med Sci Sports 2007: 17: 556–563 Copyright & 2006 The Authors Printed in Singapore . All rights reserved Journal compilation & 2006 Blackwell Munksgaard DOI: 10.1111/j.1600-0838.2006.00607.x Sports-related eye injuries: floorball endangers the eyes of young players T. Leivo, I. Puusaari, T. Ma¨kitie Helsinki University Central Hospital, Ophthalmology Clinic, HUS, Finland Corresponding author: T. Leivo, MD, PhD, Helsinki University Central Hospital, Ophthalmology Clinic, PL 220, 00029 HUS, Finland. Tel: 1358 9 4711, E-mail: tiina.leivo@pp.fimnet.fi Accepted for publication 19 September 2006 The objectives of this study were to determine the distribu- CI 228–415) floorball eye injuries occur annually. The tion of different sports-related eye injuries and to identify mean age of floorball patients was 22 years. The most injury types to enable recommendations to be made about common finding (55%) in sports injury patients was hy- the use of protective eyewear. The study population phema. Clinically severe eye injuries during this period comprises all 565 eye trauma patients examined at the accounted for one-fourth of all cases. During the study Ophthalmology Emergency Clinic of the Helsinki Univer- period, no eye injury was found in an organized junior ice sity Central Hospital over a 6-month period. Data were hockey, where facial protection is mandatory. Floorball is collected from patient histories and questionnaires. In estimated to belong to the highest risk group in sports, and addition, three severe floorball eye injury cases are pre- thus, the use of protective eyewear is strongly recommended. sented. Of the 565 eye traumas, 94 (17%) were sports We conclude that national floorball federations should make related. Of these, 42 (45%) were associated with floorball. protective eyewear mandatory. Countrywide, in Finland, estimated over 300 (195% Floorball and its amateur version floor hockey have and distribution of different types of sports-related increased rapidly in popularity in recent years both eye injuries. as competitive disciplines and as fitness, school and workplace activities. In Finland, the estimated num- ber of floorball and floor hockey players is approxi- Materials and methods mately 335 000, and these sports are also on the rise The study population comprised all new eye injury patients in other countries (Suomen salibandyliitto, Finnish of the Ophthalmology Emergency Clinic of the Helsinki Floorball Federation, www.salibandy.net). Of those University Central Hospital (HUCH) examined between who play floorball and floor hockey, about half are 3.12.2002 and 3.6.2003. The hospital register was accessed to gather data on all emergency patients during this period who aged under 18 years; their eye injuries can thus have were assigned an ICD-10 diagnosis indicating eye injury. In a lifetime negative impact and may affect career addition, during their first visit all eye injury patients were choices. Precise information on the quantity and given a questionnaire to fill out. The coverage of the data is quality of floorball- and floor hockey-inflicted eye estimated to be complete, as, firstly, the eye injury patients injuries has not been available in Finland to date, were picked up prospectively in the emergency clinic by filling out the questionnaire, and, secondly, the hospital register data and no official recommendations or mandates re- were accessed to find out all missed-out patients using ICD-10 garding eye protection exist. However, eye protection diagnosis indicating eye injury directly or indirectly, i.e. also in in association with sports is increasingly advised as a clinical practice occasionally incorrectly used non-trauma considerable proportion of these eye injuries could be diagnoses were searched to find out possible missed-out cases. prevented with protective eyewear or other appro- Thirdly, the researchers examined all case histories and con- firmed the accuracy of the injury details. priate equipment (Vinger, 2000; Parkkari et al., 2001; The questionnaire mainly dealt with background informa- American Academy of Pediatrics Committee, 2004). tion on the injury and the role played by the sport in causing Knowledge of the quantity and quality of eye injuries the accident. The main section of the form requested informa- incurred in different sports will provide players, tion on the affected eye, the date of the injury, details on the coaches, parents and sports federations with the environment, background information, use of drugs or alco- hol, the item causing the injury (i.e. the object or person necessary information to make decisions regarding striking the eye) and use of protective eyewear. The sports the use of protective eyewear. The objective of injury section enquired about the sports discipline, a descrip- this study was to determine the quantity, quality tion of the event, competitive circumstances, cause of the 556 Sports-related eye injuries accident, sports violations, insurance, earlier eye injuries Table 1. Sports-related eye injuries and other eye injuries between sustained by sports-mates in the same discipline, willingness 3.12.2002 and 3.6.2003 at the Ophthalmology Clinic of the Helsinki to use protective goggles, self-assessment of the dangerousness University Central Hospital of the sport to the eyes and any previous eye injuries incurred. Personal and examination details for all eye injury patients N % were recorded. Information on sports injury patients’ status, diagnoses, treatment, sick leave and sports restrictions was Sports eye injuries 94 17 collected from case histories. If the case history did not include Other eye injuries 471 83 a physician-issued activity restriction, the researchers evaluated Large foreign body and/or bumping 209 37 the need for such a restriction based on international health care Contact with a human body (e.g. fist, finger, limb) 81 14 recommendations (Rhee & Pyfer, 1999). This need was assessed Metal small foreign body 50 9 for each patient according to their case history. For example, Other small foreign body 42 7 health care recommendations stipulate a minimum of 2 weeks’ Organic small foreign body 7 1 restriction for microscopic or macroscopic hemorrhage of the Chemicals 25 4 Gun, slingshot and combat games 18 3 anterior ocular chamber in the absence of other status findings. Fireworks 6 1 Similarly, the number of outpatient visits required to treat the Animal-related injury 2 0 injury within a three-month period was assessed based on Burn injury 2 0 international recommendations (Rhee & Pyfer, 1999). If several Light or radiation injury 1 0 injuries were present in the eye or its vicinity, the most clinically Other 7 1 significant diagnosis was recorded as the main diagnosis. The Missing data 21 4 prevalence of sports injuries was analyzed according to sports All eye injuries 565 100 discipline. In the evaluation, floorball and floor hockey were combined into one discipline, as were the different forms of combat sports. Eye injuries other than sports-related ones were classified according to the causal agent. The prevalence of eye injuries in different sports was and they were on average younger than the other compared by determining the proportion of injuries relative sports eye injury patients (Fig. 2). Of floorball to the estimated number of participants in the sport in the Hospital Districts of Helsinki and Uusimaa (HUS). The patients, 93% were men or boys. Of all floorball estimated number of participants was calculated by dividing and floor hockey injuries, over half occurred at the the participant population in the national fitness study in sports site, about 20% at school or in day care and 2001–2002 with the population proportion in the HUS district the rest at home in the yard or at the workplace; (27.3% of the Finnish population lived in the HUS district in information was missing for approximately 10%. A 2003) (Suomen Liikunta ja Urheilu, 2002). In addition, the annual number of injuries in the different sports disciplines in floorball stick caused about one-third and a ball Finland was calculated. nearly two-thirds of the injuries. Over half of the At the end of ‘Results’ three severe sports eye injury cases injuries occurred during practices and one-fourth caused by floorball or floor hockey are presented. One of these during competition. Data were missing for approxi- cases is from the study population, and the two others mately 20% of cases. A sports violation contributed occurred outside the study period, in 2003. Informed consent and local ethics committee approval were to 10% of cases. provided for the study. Examination findings The status findings of sports eye injury patients’ initial Results examinations are provided in Table 3. No statistically Mechanisms of injury and background information significant differences were present between the find- In a 6-month period, the HUCH Ophthalmology ings of floorball patients and those of other sports Emergency Clinic treated 565 new eye injury pa- patients. At the first visit, the visual acuity of the tients, 94 of whom were sports injury patients (17%; injured eye for about half of both floorball and floor 95% CI 14–20; Table 1). The remaining 471 injuries hockey patients was subnormal (o1.0). The most comprised 63 assault cases and 324 accidents (data common deviant finding was hemorrhage of the concerning deliberateness were missing for 84 pa- anterior ocular chamber. Other findings were elevated tients). The questionnaire was filled out by 66 sports intraocular pressure, a dilated and poorly reactive eye injury patients (70%) and 162 other eye trauma pupil and retinal abnormalities (Table 3). patients (34%). The distribution of diagnoses of Among floorball patients, the clinically most se- sports eye injuries and other eye injuries is presented vere wounds were a penetrating corneal injury (Case in Fig. 1. The most common main diagnosis for 2) and a high-grade hyphema associated with exten- sports-related eye injuries was ocular hyphema.
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