Paintball injuries in children: more than meets the eye.

OBJECTIVE: To describe the increasing incidence of ocular injuries in the pediatric population caused by paintballs. The awareness of this trend will help the physician who treats the child to give appropriate care as well as educate physicians, who counsel children, about this growing mechanism of pediatric injuries.

METHODS: Previously unpublished data from the US Consumer Product Safety Commission were analyzed to find the frequency of ocular injuries in children. A review of the English-language literature was also conducted to describe trends with regard to age, sex, location at the time of injury, use of eye protection, types of injuries sustained, and long-term visual outcome.

RESULTS: The incidence of paintball eye injuries treated in emergency departments has risen from an estimated 545 in 1998 to >1200 in 2000. The proportion of these injuries that occurred in the pediatric population may be well over 40%. These injuries are seen predominantly in boys, a growing proportion of whom are playing informally in unsupervised settings and not wearing eye protection. The cases previously reported include large numbers of hyphemas, retinal detachments, cataracts, corneal abrasions, vitreous hemorrhages, and commotio retina. Many of the patients in these cases sustained permanent visual impairment, with 43% having best vision at follow-up of 20/200 or worse.

CONCLUSIONS: Pediatric eye injuries caused by paintballs are an unrecognized cause of severe injury and permanent visual loss. The advances in eye protection for participants in "war games" have had little if any effect on the youngest population. Children and teens are unlikely to wear eye protection voluntarily when playing at undesignated or unsupervised locations. Changes should be made to restrict availability of these very dangerous but easily acquired guns and ammunition. Practitioners must counsel young people and their caregivers to avoid injuries by wearing appropriate eye protection. Parents should supervise the use of paintball equipment as they would other activities that involve high-speed projectiles.