Expert Witness for Eye Injuries in Boxing

Although the actual incidence of eye injuries in boxing is not precisely known, physicians who attend ringside events are keenly aware of the high incidence and potentially devastating impact such injuries may have on vision.  Signs of ocular trauma have been found in about 21% to 58% of boxers.  An expert witness familiar with trauma to the eye may evaluate these case and provide credible testimony regarding causation, mechanism of injury, and prognosis for vision and other injuries.

The most frequent and evident injuries consist of bleeding and swelling of the eyelids.  This type of injury is commonly known to the lay person as a “black eye.”  Although this type of trauma is often dismissed, it may represent a harbinger of underlying problems that include retinal tears, retinal detachments, cataract, and dislocated lenses.

Boxing may result in complications that may develop years after a boxer has ceased boxing.  Examples include glaucoma due to damage to the anterior chamber angle and other portions of the eye responsible for circulation and drainage.  Traumatic cataract may also develop insidiously over a period of months to years before it becomes visually symptomatic.  An expert witness may be helpful in determining the extent of glaucoma and cataract that impacts vision.

The orbital bones surrounding the eye usually absorb the brunt of force from boxing gloves.  However, even a small portion of a boxing glove that contacts the eye at a high velocity can cause significant injury.  A direct blow to the eye is also know as a coup injury.  Direct blows to the area surrounding the eye can cause lid lacerations, bony fractures, and bleeding.

A direct boxing blow to the eye may result in a corneal abrasion, blood in the anterior chamber (hyphema), inflammation in the anterior chamber (iritis), cataract, damage to the iris, blood in the vitreous, injury to the optic nerve, or damage to the retina.  An eye with a corneal abrasion is susceptible to infection.

Boxing injury to the eye may also case separation of the ciliary body from the scleral spur inside the eye, angle recession, or iridodialysis.  These type of traumatic injuries may result in glaucoma after the initial boxing injury.  A normally clear lens inside the eye may become opaque as a result of blunt boxing injury to the eye.  The most common tyoe of traumatic cataract in boxers is the posterior subcapsular cataract.  This type of cataract may have a significant impact on vision, even during its early stages of development.

The natural lens of the eye is suspended in proper position with zonules.  Zonules are delicate microscopic strands.  Injury to the zonules from blunt boxing trauma can result in dislocated lenses and compromised vision.

Retinal tears and retinal detachments are among the most serious injuries that may result from blunt boxing trauma.  Retinal detachments, especially those that involve or threaten the macula, usually deserve prompt attention.  Trauma to the optic nerve may result from a fracture of the bony optic nerve canal with fragments that compress the optic nerve.

Significant force from boxing can also cause a rupture of the eye.  Intraocular contents that prolapse through the rupture can lead to infection, inflammation, and other problems.  Repair of a ruptured eye may be more complicated in the presence of  a ruptured eye.  A ruptured eye from boxing trauma usually requires prompt attention and repair.

A contrecoup injury to the eye results from a shock wave that is initiated at a point away from the eye.  A significant shock to the head can cause macular holes, cataract, or a retinal dialysis.

A variety of eye injuries can result from boxing trauma.  An expert witness may be able to analyze the nature of traumatic injury to the eye, define appropriate care, and assist in determining damages and the prognosis for visual recovery.

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References:
1) Wedrich A, Velikay M, Binder S, et al. Ocular findings in asymptomatic amateur boxers. Retina, 1993;13(2):114-119

2) Giovinazzo VJ, Yanuzzi, LA, Sorenson JA, et al. The ocular complications of boxing.  Ophthalmology 1987;94(6):587-596

3) Maguire JI, Benson WE. Retinal injury and detachment in boxers. JAMA 1986; 255(18):2451-3

4) Corrales G, Curreri A. Eye trauma in boxing. Clinical Sports Medicine 28(2009):591-607

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