Issue 141

Dr. Jonathan Gelber investigates the issues involving one of any contact sport's most common accidental injuries - eye pokes.

During a UFC bout in 2012, Wagner Prado saw two opponents across the Octagon from him – and both of them were Phil Davis. Prado had been accidentally poked in the eye little more than a minute into the opening round and was seeing double, forcing the ringside physician to call off the Brazilian’s debut. So, what happens when your eye gets struck by a finger?

ABRASIONS

Eye injuries in MMA fall under two main categories: abrasions and blunt trauma. Abrasions usually affect the cornea or the outer blood vessels of the eye. They can occur when the eye is scratched; usually by a fingernail, a toe, or even a glove.

The cornea is the clear portion that covers the center of the eye. When the cornea is injured, it feels like a sharp pain and often gives the sensation that there is something in the eye. Doctors are usually able to diagnose a corneal abrasion by staining the eye with a special dye and seeing if a scratch or tear appears under a fluorescent light. 

Pain can often be so severe that even bright lights cause the eye to want to close, making it incredibly difficult for a fighter to adequately defend himself after experiencing a corneal abrasion. Treatment usually consists of antibiotic drops, to prevent infection. Minor scratches can heal in just a couple of days, but larger abrasions can take a lot longer.

If the eye poke misses the cornea, but instead catches some of the other outer coverings of the eye, the blood vessels of the eye can be sheared. This is called a sub-conjunctival hemorrhage, which appears as red in the normally white part of the eye. 

As a result, blood can be seen in the eye, which is called hyphema. Fighters are usually able to continue with this injury, and it often resolves on its own within two weeks. However, if bleeding resumes, it can lead to serious consequences, such as vision loss.

BLUNT TRAUMA

The more serious eye gouge injuries usually come from blunt trauma. This kind of injury is actually more common in sports where there are flying projectiles, such as a ball, but it is not impossible that a knuckle, finger or elbow could impact the eye directly. 

The major part of the eye is an oval, fluid-filled structure known as the globe. Direct impacts to the eye by an eye poke can cause the fluid inside the oval to compress on one side and result in expansion of the fluid in the other areas, leading to transmission of forces to other parts of the eye. 

Blunt trauma affecting areas larger than the globe, may be absorbed by the bones around the eye leading to orbital fractures – like the one suffered by Josh Koscheck in his UFC 124 fight with Georges St-Pierre.

With compression of the globe in the front and resulting expansion, the retina or optic nerve at the back of the eye may be injured or torn. The eye focuses light on the retina similar to how a camera focuses light onto a sensor. The retina translates that focused image into neural impulses and sends them to the brain. If the retina is damaged, the person may see flashes of light, or ‘floaters.’ If it tears completely, a person could go blind.

At times, bleeding may happen inside the eye. If a ringside physician looks into a fighter’s eye, an actual layer of blood will be seen. Often these bleeds are small and resolve on their own if the bout is stopped in a timely manner, but sometimes they can progress or bleed again and this can lead to permanent vision problems, including glaucoma.

With enough force applied to the eye, the globe itself can actually rupture. This usually results in pain, vision loss, or even actual leakage of the fluid within the globe. This often requires prompt evaluation by an eye doctor (ophthalmologist). Sometimes the globe itself doesn’t rupture, but the force can lead to bleeding behind the eye (retrobulbar hemorrhage). That's a potential surgical emergency.

Sometimes the eyeball itself is not damaged, but the eyelid can be lacerated. If this happens, any further contact could make the tear worse. 

PREVENTION

Given the potentially severe and life-altering nature of these eye injuries, the role of the ringside physician is crucial. What the ringside doctor sees on an exam not only determines whether a fighter can continue, but also whether the fighter may need vision-preserving emergent surgery. Eye pokes may seem minor, but they can have devastating consequences. A fighter may feel he can continue, but could risk further injury.

The vast majority of eye injuries in sport can be prevented with eye protection – not possible in MMA. Other than a physical barrier, there isn’t anything anyone can do to ‘strengthen’ the eye against injury. Some have suggested a redesign of MMA gloves as a way to reduce eye injuries.

After all, traditional boxing gloves contain the fingers, reducing the incidence of eye pokes. MMA gloves, however, crucially allow the fingers to be exposed for grappling. Yet this also leads to more severe eye injuries. Perhaps as the sport evolves, so must the equipment.

PRO TIP: Anti-inflammatories may increase a fighter’s risk of further bleeding and should be avoided in this injury.