Matas Mikalauskas, Karolis Strašunskas, Edita Puodžiuvienė
Abstract
Ocular trauma is a significant concern in combat sports, where high-impact strikes frequently cause injuries ranging from mild superficial lesions to severe anterior or posterior segment damage capable of impairing vision. This narrative review examines ocular injury mechanisms in boxing, mixed martial arts, kickboxing, and other combat disciplines, describing the typical effects of blunt impacts that lead to eyelid lacerations, hyphema, orbital fractures, lens displacement, vitreous hemorrhage, retinal tears, and retinal detachment. Diagnostic evaluation is often complicated by periorbital swelling, pain, and media opacity, which may delay recognition of posterior segment pathology, while modern imaging techniques—including ocular ultrasonography, computed tomography, and optical coherence tomography—enhance early diagnosis and treatment planning. The review also summarizes evidence-based preventive measures, such as appropriate protective equipment, adherence to safety regulations, medical screening, and rapid assessment by ringside medical personnel, all of which contribute to reducing the risk of severe ocular injuries. A deeper understanding of trauma mechanisms, diagnostic limitations, and prevention strategies is essential for decreasing the incidence and severity of ocular injuries in combat sports.
Keyword(s): ocular trauma, combat sports, eye injuries, diagnostics, prevention, retinal detachment, lens displacement. Introduction Combat sports such as boxing, mixed martial arts (MMA), kickboxing, and related disciplines pose a substantial risk of craniofacial trauma due to the intentional and repeated delivery of high-energy strikes to the head and upper body. Among these, ocular trauma stands out as both prevalent and potentially career-threatening, even in the absence of immediate visual symptoms). The delicate anatomical structures of the eye—particularly the orbit, retina, and cornea—are vulnerable to both acute blunt force and cumulative microtrauma, with consequences ranging from minor abrasions to irreversible vision loss [1]. Despite ongoing efforts to enhance safety through rule modifications and protective equipment mandates, recent data suggest that eye injuries remain a persistent concern in combat sports. Fliotsos et al. (2021) reported that 73.3% of professional MMA events in Nevada involved at least one documented eye injury, with similar trends noted across boxing and kickboxing. Injuries frequently include orbital fractures, retinal tears, hyphema, and corneal abrasions, often underdiagnosed or managed inconsistently due to limited ringside resources and the absence of standardized returnto- play protocols [2]. While individual studies have examined injury types or reported isolated epidemiological findings, a comprehensive review comparing mechanisms, clinical challenges, and prevention strategies across combat sports remains lacking. Moreover, diagnostic and reporting limitations—such as injury underreporting or limited access to ophthalmologic evaluation—complicate interpretation and delay optimal care. This literature review aims to synthesize current evidence from 2015 to 2025 on: 1. The mechanisms and anatomical distribution of ocular injuries in combat sports. 2. The diagnostic limitations and clinical challenges in managing such injuries. 3. Existing preventive strategies and opportunities for evidence-based improvement. By mapping the patterns and gaps in current data, this review supports clinicians, ringside physicians, and sport’s governing bodies in designing safer practices for combat athletes globally. Žurnalo tinklalapis: https://sm-hs.eu Correspondence to: Matas Mikalauskas, e-mail: matamika0617@kmu.lt.
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