A Unique case of Globe injury during lockdown period

INTRODUCTION

Badminton is a very popular sport in India and is played by all age groups and socioeconomic segments. This sport can result in injuries mostly minor like sprains, cramps, ankle fractures, wrist sprains. However, in ophthalmic injuries only 6% of all injuries are due to shuttlecock and 7% by racquet¹ . The incidence of ocular injuries is regionally dependent and is dependent on the popularity of the sport² . About half of these patients can suffer a permanent reduction in vision out of which 11% had a final visual acuity of 6/60 or worse³ . The incidence of open globe injury is less than closed globe injuries in badminton. Double games are more prone to ocular injuries than single game⁴ .

Shuttlecock caused more accidents than racquets but injuries from racquets were severe producing enough force to knock someone down, break their eye glasses or even rupture the eyeball. We report an unusual case of open globe injury which occurred in a single’s game. The patient was wearing his spectacles and was hit by the shuttlecock in his right eye which led to shattering of eyeglass and open globe injury.

Case Report

A 26-years old male, presented with complaints of sudden onset of diminution of vision in the right eye following injury in a double’s badminton match during the coronavirus lockdown. During a match, the patient’s doubles partner, hit a smash shot which injured the patient’s right eye when the patient, an amateur badminton player, turned around to check whether his partner had taken the shot.

Post-injury the patient developed pain, redness, and sudden onset diminution of vision. On evaluation, his visual acuity in left eye was 6/6 , Right eye was hand movement close to face (HMCF) with perception of light present and projection of rays accurate, not improving with pin hole. Slit lamp evaluation showed presence of corneal edema, 3+ cells in the anterior segment, iridodialysis from 10 clock to 50 Clock position (almost 180 degrees). Pupil was D-shaped and not reacting to light with traumatic mydriasis (Fig.1 and 2).

Fundus was not visible due to severe anterior uveitis and corneal oedema. His intraocular pressure was elevated (24mmHg). He was diagnosed as a case of closed globe injury. Patient was managed conservatively with topical and systemic steroids. Antibiotic, cycloplegic eye drops and antiglaucoma medications. Anterior chamber reaction subsided after 5 days of steroid therapy and media clarity improved. However visual acuity improved to 2/60 with no further improvement. Detailed fundus examination was carried out which showed a macular scar with typical rosette cataract formation following blunt trauma (Fig. 3).

As the present circumstances(lockdown) did not allow elective surgeries, the patient has been planned for cataract surgery in the near future with guarded visual prognosis.

DISCUSSION

Serious ocular trauma can occur in sports like ice hockey, squash, tennis and golf^5,6. Double’s games players of Badminton are at higher risk of ocular injury than those in single’s games. Most of the players were hit by their partners than by opponents, by shuttlecocks or racquets^2,4-5. The different mechanisms of injuries associated with badminton are, injury due to: (1) a smash shot from an opponent with player at the net, which occurred in our case (2) shuttle bouncing off the player's racquet and hitting his eye, (3) racquet of partner hitting the player and (4) an uncommon mechanism due to shuttle injury during a smash shot from the doubles partner when the player turns around to look at the miss-hit shot³ .

Closed globe injuries are more common in Badminton which occurs due to shuttlecock. Open globe injuries are relatively less common and occurs due to racquet injury directly to the eye or to the spectacles worn by the player, resulting in shattering of the spectacle. Even frames itself causing serious eye injury has been reported7 . American Academy of Paediatrics and the American Academy of Ophthalmology have recommended that all youth participating in organized sports wear eye protection⁸ . In the specific case of individuals who wear spectacles, they recommend several options, including polycarbonate lenses in a sports frame, contact lenses with appropriate sport-specific protective eyewear⁸. This case highlights the importance of wearing protective glass in badminton sports...

CONCLUSION

This case shows the importance of wearing protective eyewear while playing racquet sports. We strongly recommend using protective eyewear even on the top of eyeglasses especially in untrained or young players.