A 10-Year Survey of Severe Eye Injuries in Sport in Belgrade, Serbia 2000-2009

doi:10.4236/ojoph.2013.33022

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Open Journal of Ophthalmology, 2013, 3, 93-96

http://dx.doi.org/10.4236/ojoph.2013.33022 Published Online August 2013 (http://www.scirp.org/journal/ojoph)

A 10-Year Survey of Severe Eye Injuries in Sport in

Belgrade, Serbia 2000-2009

Miloš Jovanović1*, Dragan Vuković1, Vesna Jakšić2, Miroslav Knežević1, Lepša Žorić2,

Miloš Mirković2

1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Faculty of Medicine, University of Kosovska Mitrovica, Kosovska

Mitrovica, Serbia.

Email: *[email protected]

Received January 23rd, 2013; revised February 24th, 2013; accepted March 15th, 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Introduction: The eye injuries inflicted in different sport activities are relatively rare and depend upon the type of sport.

They are more common in recreational sport activities. These injuries are generally minor but may be very severe and

result in permanent vision impairment. One must be aware of the fact that these sport activities, either recreative or pro-

fessional, are exercised by young people. Methods: All analyzed patients were hospitalized at the Clinic of Eye Dis-

eases, Clinical Center of Serbia, Belgrade, for severe eye injuries which occurred in sport activities. The analyzed pe-

riod included 10 years, from the beginning of 2000 to the end of 2009. Results: In this period, a total of 117 patients

with eye injuries sustained in some of sport activities were hospitalized. There were 114 (97.5%) injured males. Mean

age of the injured was 25.8 years, and there were no individuals older than 50 years of age. Closed eyeball injures were

reported in 96.6% and open injuries were seen in the remaining 3.4% of cases. During recreational sports, the eye inju-

ries occurred in 76.1%, in the school—19.6%, and in professional sport—4.3% of the time. The injured individuals

were as follows: pupils—35.0%, students—17.9%, workers—22.2%, clerks—20.6% and professional players—4.3% of

cases. Upon completed treatment, visual acuity was normal in 77.8%, subnormal in 16.2%, impaired in 3.4% and

amaurosis in 2.6% of cases.

Keywords: Eye Injuries; Sport Activities; Recreation; Eye Protection

1. Introduction

In the past decade, the incidence of sport eye injuries

tended to have increasing growth [1,2]. Garrow, in 1923,

reported that the sport eye injuries accounted only for

0.7% of all patients admitted for treatment of their eye

injures in the Glasgow Royal Infirmary [3]. Canavan et al.

in 1980 reported the incidence of sport eye injures of

4.1% [4], and Jones, in 1988, showed the increase of

percentage to 25.1% [5], while in MacEwen’s paper,

1989, the proportion of sport eye injures was 42.2% [6].

At the beginning of 21st century such percentage was

decreased, and therefore, Barr et al., in their study in

2000, reported the sport eye injury incidence of 12.5%

[2], and in 2007 study by Len et al., such percent was

11% [7]. This paper analyzes the incidence, nature of

injury and functional sequelae of sport injuries in Serbia

in the first decade of our century.

2. Material and Methods

The paper analyzed the patients who sustained the eye

injuries in sport activities. Due to severity of eye injuries,

they were all hospitalized and treated at the Clinic of Eye

Diseases, Clinical Center of Serbia in Belgrade. The ana-

lyzed period of time was 10 years, from January 1, 2000

to December 31, 2009. Data from the Registry of in-pa-

tients of the Clinic of Eye Diseases, Clinical Center of

Serbia in Belgrade were used in this investigation. Hos-

pitalized injured patients played football, tennis, basketball,

handball, water polo and paintball as recreational activi-

ties, in school at gym classes or as professional activities.

The following parameters were analyzed: age, site of

injury, occupation, nature of the eye injury, as well as

final visual acuity of the injured eye.

The objective of this investigation was to establish the

frequency of the eye injuries in different sport activities,

types of injury, final visual acuity and probable options

*Corresponding author.

A 10-Year Survey of Severe Eye Injuries in Sport in Belgrade, Serbia 2000-2009

of undertaking specific preventive measures.

3. Results

In the analyzed 10-year period (2000-2009), a total of

3206 patients were hospitalized at the Clinic of Eye Dis-

eases, Clinical Center of Serbia in Belgrade, for serious

mechanical injuries. Out of this number, 117 (3.6%) pa-

tients sustained their eye injuries during some sport ac-

tivities (Table 1). All but 3 injured were males; 2 girls

had their eyes injured by tennis ball and the third girl was

injured while playing the handball. The right eye was

wounded in 70 (59.8%) cases. There was no patient with

simultaneous injuries of both eyes. In general, the injuries

occurred in children and younger adults, and not after the

age of fifty (Table 2). Mean age of the injured was 25.8

years.

Closed injuries were reported in 113 (96.6%) patients

and open injuries were evident in the remaining 4 (3.4%)

cases. In closed bulbar injuries, there were different

damages of the intraocular structures, and in open injuries

two cases manifested penetrating injuries and two other

cases had rupture of the eye ball (Table 3).

The majority of injuries occurred in recreational sport

activities—76.1%, followed by school—19.6% and in

professional sports—only 4.3%.

The occupation of the injured patients was different

and with different percentage of involvement: pupils,

students, workers, clerks, and professional players (Table

4).

Upon completed treatment, visual acuity was normal in

77.8%, subnormal in 16.2%, impaired vision in 3.4% and

amaurosis in 2.6% of cases (Table 5).

4. Discussion

Our study showed that the percentage of sport eye inju-

Table 1. The number of the injuries in different sports.

Sport No. of sports %

Football 95 81.2

Tennis 10 8.5

Basketball 4 3.4

Paint ball 4 3.4

Water polo 3 2.6

Handball 1 0.9

Total 117 100.0

Table 2. Distribution by age of patients with sport eye inju-

ries.

Year 0 - 9 10 - 19 20 - 2930 - 39 40 - 49 Total

3 42 39 22 11 117

No. of

patients

% 2.6 32.9 33.318.8 9.4 100.0

Table 3. Types of the sustained injuries.

Injury No. %

Closed globe 113 96.6

Hyphaema 96 82.1

Iridodialysis 17 14.6

Subluxatio lentis 9 7.7

Cataract 3 2.6

Vitreous hemorrhage 15 12.8

Retinal hemorrhage and edema 36 30.8

Open globe 4 3.4

Penetrating 2 1.7

Rupture 2 1.7

Total 117 100.0

Table 4. Occupation of patients with the eye sport injuries.

ProfessionPupilStudentWorkerClerk Professional playerTotal

No. of

patients 4121 26 22.2 5 117

% 35.017.924 20.6 4.3 100.0

Table 5. Final visual acuity (VA) of patients.

Final VA N0 of patients %

20/25 - 20/20 91 77.8

20/50 - 20/30 19 16.2

1 m to 20/60 4 3.4

Amaurosis 3 2.6

ries on the territory of the city of Belgrade of 3.6% was

significantly less in comparison to percentage of the same

injuries reported by other authors [3-7]. There are several

reasons for the aforementioned. The first reason is that,

under current conditions in Serbia, the eye injuries occur

most commonly in public places, at home and during

work. In this way, an overall involvement of sport inju-

ries has been reduced [8]. The second reason is that the

indications for hospitalization are narrowed, and accord-

ingly, a large number of sport eye injuries is managed on

outpatient basis, and our study analyzed only sport eye

injuries in hospitalized patients. The same reason for re-

duction of sport eye injuries was reported by other au-

thors in their papers [9,10]. The third reason is a modifi-

cation of population age structure. In today’s Serbia, the

percentage of adult young people has been continuously

decreasing, and these young people are actually the indi-

viduals going in for sports. Unfortunately, better eye pro-

tection cannot be reported as the reason for lower per-

centage of eye injuries, because no protection devices,

except in paintball, are generally used in our setting.

Football was the commonest cause of the eye injuries.

Such cause was mentioned by other authors as well [11,12].

Football is the most popular sport in Serbia, being played

A 10-Year Survey of Severe Eye Injuries in Sport in Belgrade, Serbia 2000-2009 95

in different professional leagues or more often, just for

recreation purposes. That is why the eye injuries are more

frequent in football players playing it for fun. Only three

cases were reported among professional football players.

In one case, the injury was caused by blow of the oppo-

nent player’s elbow, resulting in bulbar rupture and

amaurosis. Other two open (penetrating) wounds of the

eyeball occurred in recreating football players, namely,

one sustained it while falling down and hitting the eye

against some prominent object on the ground and another

in similar way, by some sharp object on the playground.

The second game by frequency of the eye injuries was

tennis. Out of 10 (8.5%) tennis injuries, seven was caused

by racquet and three by ball. In all cases it was the ques-

tion of contusion globe injuries. Regarding the basketball,

the injuries were present in only 4 (3.4%) of all intrahos-

pitally-treated sport eye injuries. One of these injuries

occurred in professional basketball player. Three injuries

were reported in water polo, i.e. one in professional

player, which was caused by blow of the opponent player

and resulted in rupture of the globe. Only one patient

with the eye injury was reported in case of handball. It

was the contusion of the globe in a school-girl who sus-

tained her injury during gym class.

Although all these aforementioned sports after football

are relatively popular in Serbia, far lower percentage of

the eye injuries in other sports than football is accounted

for their lesser prevalence in recreational sport activity.

Recently introduced sport—paintball—is played in Serbia

only as recreation activity. Although adequate protective

devices are provided by regulations, 4 very serious inju-

ries were noted. All injuries occurred at the moment

when players’ goggles were off. In all 4 cases the patients

were adults, and 2 of them sustained severe injuries with

consequent loss of vision. One of these two patients was

a surgeon whose loss of vision disabled him to continue

with his surgical profession.

It is interesting that, during 10-year analyzed period,

there was no hockey player or boxer, although these two

sports represent activities with frequent eye injuries, what

was also reported by other authors [13-15].

Opposite to high proportion of injuries in recreational

sports, the reason for so small number of injuries in pro-

fessional players lies in their well-coordinated team play,

instructions given by their coaches and respect of the

basic rules of game.

Eye protection measures of sport players analyzed in

this study, other than paintball, are not provided by regu-

lations and, therefore, they are not applied. Nevertheless,

it does not mean that it is the issue not to be contemplated

on in future.

5. Conclusion

The conclusion has been reached that the eye injuries

during different sports mostly occurred in young people

who exercised sport as recreation. In a largest number of

cases, it was the question of contusion injuries of the

globes with the damage of intraocular structures. One-

third of the injured had the impaired vision of the injured

eye. For this reason, the prevention of injuries with strict

respect of the rules of games and wearing of protection

devices, if provided for specific game or sport, should be

given preference.

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