Trends in Hockey-Related Ocular Trauma

Importance: While hockey has been listed as a leading sport associated with eye injuries by the American Academy of Ophthalmology, characterization of hockey-related ocular trauma and injury severity and type remain limited. Objective: To characterize epidemiologic trends and hockey-related ocular trauma in the US. Design, Setting, and Participants: This was a cross-sectional study conducted from January 2004 to December 2023 using the National Electronic Injury Surveillance System (NEISS). NEISS was queried for hockey-related eye injuries based on product codes for hockey and body part code for eyeball. NEISS's built-in algorithm for estimating national incidence was used, and patient demographic characteristics, hockey type, and injury mechanism, diagnosis, and severity were analyzed. Data were analyzed from January to March 2025. Exposure: Hockey participation. Main Outcomes and Measures: National incidence of injuries, injury type, and severity. Results: A total of 215 cases were identified, extrapolating to 6466 US cases (95% CI, 3736-9195) over the last 20 years. Of 215 patients, 169 were male (79%), 148 were pediatric (<18 years; 69%), and 178 had equipment-related trauma (83%). Protective goggle use was reported in only 4 cases (2%). Injury incidence was similar among ice (23 [11%]), field (21 [10%]), and street hockey (23 [11%]). Minor anterior segment injuries were common (136 [63.3%]). Thirty-two (15%) patients had multiple ocular injuries. Of 259 total diagnoses, 32 (12%) were vision-threatening injuries. Pediatric patients had more minor anterior segment injuries (95 of 148) compared with adults (31 of 67; 64% vs 46%; difference, 18%; 95% CI, 3.8-31.9; P = .02), while adult patients had more major posterior segment injuries (4 of 67; 6% vs 0%; difference, 6%; 95% CI, 1.6-14.4; P = .009). Male individuals had more major anterior segment injuries (35 of 169) than female individuals (1 of 46; 21% vs 2%; difference, 19%; 95% CI, 7.9-25.5; P = .002). Conclusion and Relevance: Hockey-related eye injuries can be severe and vision threatening. Optimal care may require prompt and thorough assessment and appropriate management of ocular and periorbital trauma. The low prevalence of reported goggle use in this investigation supports the need for greater awareness and advocacy for protective eyewear to reduce the risk of vision-threatening hockey-related injuries.