RICE & MICE: Eyes wide shut? Should we continue to ignore the need for visors in the NHL?

In light of Chris Pronger’s eye injury on Monday night, I decided to postpone what I was going to share with you today in favor of a look at eye injuries. 

While the injury report on Pronger is vague as always and I can’t speak with authority on his particular injury, I can say that there are far too many preventable eye injuries every year for the league and NHL Players’ Association to continue to ignore.

Visors would help prevent many of these injuries and it’s time to address the need for eye protection in the NHL. For a league that requires eyesight in both eyes, protecting players from potential vision loss in an eye should be a no-brainer.

First, let me go over the basic anatomy of the eye.  The white of the eye is called the sclera and is covered by the thin, transparent conjunctiva. The cornea is a clear covering over the iris (the colored part) and the pupil. The space between the cornea and the iris is the anterior chamber; the space behind the lens is the posterior chamber and is filled with a jelly-like substance called vitreous humour.

One injury that I’m not going to talk about in depth that can affect vision in the eye is the fractured orbital bone. I have seen several of these in the past 10-15 years, all of them caused by different things, all of them resulting in slightly different injuries.

A corneal abrasion is a scratch on the cornea. There are many nerve endings in the cornea, which makes this injury very painful. The affected eye may be red and watery and it may feel like there is something stuck in the eye and vision may be blurred. Corneal abrasions can occur when something hits the eye or if small particles get in the eye. An ulcer can form as a result of some infections or from constant contact lens use.

A corneal abrasion can be seen by putting some fluorescent dye in the eye and looking at it with a blue or black light. The light will cause the abrasion to glow from the dye. Corneal abrasions may be treated with numbing medication initially and the eye should be flushed in case of debris. Most of the pain from a corneal abrasion can be treated with acetaminophen and rest and will be better within 48 hours. Sometimes anti-inflammatory eye drops can be prescribed in severe cases.

The conjunctiva of the eye contains many small blood vessels that can easily be damaged. When damage to these blood vessels occurs, blood seeps in between the conjunctival layer and the sclera causing one of the less severe but nonetheless impressive looking subconjunctival hemorrhages.  This can be the result of trauma, but can also occur spontaneously or from straining, coughing, sneezing or high blood pressure. It is usually painless and does not affect vision. It should resolve over the course of a couple of days.

A hyphema (high-fee-muh) is a collection of blood in the anterior chamber of the eye between the cornea and the iris usually resulting from blunt trauma to the eye. The collection of blood may partially or completely block vision in the eye. A hyphema may resolve with conservative treatment or it may require surgical intervention. The collection of blood may cause pressure in the eye to increase and may be quite painful.

The treatment plan for a hyphema includes bedrest or limited activity, elevation of the head of the bed and wearing of an eye shield at night time. Aspirin, ibuprofen and similar drugs are avoided due to bleeding risks.

Retinal detachment can cause permanent vision loss and usually results from blunt trauma to the eye. The retina is a thin film that lines the inside of the posterior chamber that receives images and transmits them as nerve impulses through the optic nerve to the brain. When trauma compresses the eye and causes the shape to change, the retina may detach or tear allowing the vitreous humour to seep between the retina and the back of the eye.

When this happens, the blood supply cannot get to the retina and the nerve damage results in loss of vision. There is no pain, but retinal detachment may cause floaters, shadows or sudden vision loss. Sometimes the vision loss is described as a curtain dropping over the field of vision. Treatment is surgical and lots of cases are successfully repaired, though more often than not, they require multiple surgeries.

Sometimes trauma to the eye can cause glaucoma as in the case of Mattias Ohlund, who required a tube implanted to allow fluid to drain. Glaucoma is a buildup of pressure in the eye that puts pressure on the optic nerve and can damage the nerve. Ohlund also had a hyphema that resulted from his eye injury.

Bryan Berard also suffered a detached retina when Marian Hossa’s stick smashed into his face back in 2000, and though he returned to play in six more NHL seasons, he is legally blind in the right eye.

I had planned to make a timeline of eye injuries in the NHL in the past 10 years, but I’m somewhat limited in how much space I want to take up here. In other words, there have been a lot.

Much like the move to mandate helmets, there has been a feeling among some that visors will be mandated at some point and it’s just a matter of time. Unfortunately, as long as it’s left to the players’ choice, there will always be players that don’t wear one. It’s not just the “old guys” that opt to play without one, many younger players (even though most have grown up wearing a full shield, or some sort of facial protection) choose to be visor less in the NHL.

Visors won’t prevent every eye injury, but they will reduce the number of them.  Visors could prevent potentially career ending injuries, as an injury that causes significant vision loss in one eye is the end of an NHL career.  Obviously, it’s not going to be a unanimous decision for the NHLPA, but maybe the decision shouldn’t necessarily be theirs to make.

Opponents of visors have claimed that injuries will still occur, that moral hazard will cause more reckless behavior with sticks and pucks, that implementing mandatory visors would take fighting out of the game. That last one, by the way, has been heartily disproven by the AHL.

Instead of continuing to dodge the issue, an approach like that of mandating helmets, just needs to be taken and a visor rule should be grandfathered in. Players don’t complain about what a hassle it is to wear a helmet, right? After some time, they won’t complain about a rule implemented that could potentially save their career.