Shinty and ocular trauma in north west Scotland
- Dr Purdie.
- Accepted 3 June 1998
Editor,—Sports related eye injuries account for up to 42% of ocular trauma requiring hospitalisation1 and 10% of ruptured globes.2 The commonest cause of sports related ocular trauma seen in this department is shinty.
Shinty is a parochial game with a devoted following and a playing area which stretches from Argyll and Bute in the south to Inverness in the east to Skye in the west. It is derived from hurling and is thought to have been introduced by St Bridget who travelled to Scotland with St Columba to promote christianity in the highlands.
The game itself is not unlike hockey with two opposing teams who attempt to score more goals than the opposition using a curved stick or “caman”. Two notable differences exist between the two games, however. There is no restriction on the height above which the caman may be raised or above which the ball may travel.
We report two cases of ocular trauma which are representative of the cases commonly seen in this department during the shinty season.
A 30 year old man was admitted after being struck on the face with a shinty stick.
Visual acuity was perception of light only. A 10 mm horizontal upper lid laceration was noted with a 200 degree superior iridodialysis. The lens was subluxated inferiorly with zonular dehiscence above. Intraocular pressure was 15 mm Hg with no orbital fracture.
After initial primary repair of the lid the patient was treated with topical steroids and antibiotics. The eye settled with visual acuity of counting fingers. One month after the original injury an acute rise in intraocular pressure to 54 mm Hg was lowered medically before lensectomy and anterior vitrectomy. Much of the disinserted iris was also removed.
Six months after the original injury visual acuity was 6/12 with an aphakic correction.
A 29 year old man was struck on the left eye by a shinty ball. Visual acuity was no perception of light. A partial thickness upper lid laceration was present and the globe was clearly ruptured and disorganised.
Examination under anaesthesia revealed a full thickness laceration of the globe extending for a total of 20 mm and involving the whole corneal diameter. Uveal tissue and vitreous were seen to be prolapsing through the wound with no identifiable lens. A primary enucleation was performed. The patient currently has visual acuity of 6/5 in the right eye with no evidence of sympathetic ophthalmia.
Shinty related ocular trauma causes significant ocular morbidity and occasionally the injuries are devastating. Patients are exclusively male.
Unfortunately, the globe is particularly vulnerable owing to the nature and dimensions of the equipment used in shinty. The diameter of the ball (6.03–6.36 cm) and the head of the caman (no greater than 6 cm wide)3 allow portions of both to traumatise the globe with only partial protection from the orbital rim. The ball is also very hard, comprising an inner core of dense cork with an outer layer of leather3 and can reach speeds of up to 80 miles per hour.
The recent spate of shinty related injuries has reopened the debate as to whether the wearing of faceguards or helmets should be compulsory during formal matches and practice sessions. At present, such protection is optional, including physical education at school.
We feel that faceguards and helmets should be worn at all levels of the game and should be compulsory with particular emphasis on enforcement at school and junior levels. Until the traditionalists who feel that the game is in some way “spoiled” by protective headgear relent, this easily preventable sports injury will continue to cause serious ocular morbidity in the highlands of Scotland.