The incidence of sports-related ocular injuries is rising sharply, with a 33% increase in cases treated in the United States in 2024, according to data from Prevent Blindness and the National Electronic Injury Surveillance System (NEISS). Experts are warning that many of these injuries are preventable with appropriate eye protection, yet uptake remains low across many sports.
A study co-authored by Wendy W. Lee, MD, of Bascom Palmer Eye Institute, University of Miami, focused on sports-related orbital fractures between 2014 and 2023. The research revealed a gradual increase in fractures, with a temporary dip during the COVID-19 pandemic followed by a rapid resurgence. Baseball and bicycling were identified as the sports most frequently associated with these injuries, accounting for 28.6% and 23.1% of cases respectively. The majority of injuries occurred in males (79%) and individuals aged 10-19.
Dr. Lee explained that the size and velocity of sports equipment are critical factors in the severity of injuries. “Baseball happens to be the perfect size to fracture an orbit,” she said. “It is too big to penetrate and rupture the eye, but it ruptures the orbit bones.” Bicycling injuries often result from falls and a lack of adequate eye protection, she added.
Beyond orbital fractures, injuries range from eyelid lacerations and corneal abrasions to more severe conditions like retinal detachments. Chris R. Alabiad, MD, also of Bascom Palmer Eye Institute, emphasized that the type of injury depends on the level of contact in a sport and the characteristics of the equipment involved. Smaller, faster objects pose a greater risk of penetrating injuries, even as larger objects can cause contusions and distortion of the globe.
Harry W. Flynn Jr., MD, also at Bascom Palmer Eye Institute, highlighted the potential for injuries even in seemingly less risky sports like swimming. He recounted a case of a swimmer losing sight due to contact with another swimmer’s hand during a race. “Everyone playing sports should be aware of the need to protect their eyes,” he stated.
Recent data indicates a significant increase in injuries related to pickleball. A cross-sectional study published in JAMA Ophthalmology, led by Jonathan C. Tsui, MD, of Rutgers RWJBarnabas Jersey City Medical Center, found an estimated 3,112 pickleball-related ocular injuries between 2005 and 2024, with 1,262 occurring in 2024 alone. This surge correlates with a 311% increase in pickleball participation since 2020. Adults over 50 are particularly vulnerable, accounting for 70% of reported injuries.
Dr. Tsui noted the unique characteristics of pickleball that contribute to the risk. “Pickleball is played on a small court, the ball is moving very quickly, and players are not stationed very far from others across the net or their partners,” he said. “You’ll see many injuries related to the ball and paddle but also to falls, as plays move around on a congested court.”
Effective management of ocular trauma requires prompt intervention and collaboration between specialists. Dr. Alabiad explained that injuries often involve multiple areas of the eye, necessitating a team approach. “If all you have is a corneal laceration, it’s very likely that you will be well served by just management by an anterior segment surgeon. But if the corneal laceration also includes a foreign body that has reached the vitreous cavity, you need to have a retina surgeon involved.”
While organizations like the American Academy of Ophthalmology and Prevent Blindness recommend ASTM-certified eye guards, adoption remains inconsistent. USA Pickleball recently declined to mandate eye protection, citing challenges with enforcement. Dr. Lee has shared her orbital fracture study with the Major League Baseball Players Association in hopes of prompting increased awareness and protective measures.
Amanda Nanasy, OD, of Florida Institute of Sports Vision, emphasized the importance of optimizing vision through regular eye exams and sports vision training. She noted that even minor visual imbalances can increase the risk of injury and that training can improve awareness and reaction time. She described a case where prism glasses helped a concussed athlete return to play after addressing a binocular vision issue.
