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AAP News Vol. 24 No. 1
January 2004, p. 17
Mission: Paintball safetyProper equipment use in a supervised setting should be main objectiveGreg McConnellEditorial Intern Despite improvements in eye protection devices (EPDs), paintball injuries have increased in recent years because a growing proportion of games are being played in unsupervised settings, according to a study in the January Pediatrics.
Paintball is particularly popular among males, which is why they represent most of the ocular injuries. In addition, a disproportionate number of injuries are occurring in the pediatric population (
Listman DA. Pediatrics. 2004;113:e15-e18
How the game is played Paintballs are small gelatin capsules filled with nontoxic, water-soluble paint. They are fired at 300 feet per second from a CO2-powered marker, a.k.a. paintball gun, and splatter on impact. If a paintball hits the body, often nothing more than a sting or small welt occurs. However, since a paintball is small enough to strike the eyeball, the resulting ocular injuries can be severe. As paintball grows in popularity, more questions are being asked about the sport and its risks. Not everyone, however, agrees on the answers. Some say paintball simulates war and can encourage unhealthy aggression, while others maintain it is a fun, safe sport. Organized games are played on more than 2,500 commercial paintball fields in the United States. Two teams try to capture each other’s flag, while referees officiate and oversee proper use of EPDs. However, since major sporting goods retailers sell paintball markers to anyone over 18 years of age, more households have access to the equipment to play the game in unsupervised settings. Ocular injuries tend to occur during this "backyard" play. Nature of eye injuries
"If (the paintball) doesn’t penetrate the eye, they can have severe blunt trauma consisting of hyphema, iris tearing, cataract and retinal hemorrhagic bruising (commotio) typically in the macula," said Dr. Weishaar. "If it does penetrate the eye, frequently additional injuries include corneal laceration plus, again, a traumatic cataract, the iris tearing and retinal detachment, all of which results in severe permanent visual loss." Dr. Weishaar has seen cases in which a person mistakenly thinks a game is over, takes his mask off and gets hit. He also has seen cases in which not all of the players are wearing masks because there isn’t enough equipment to go around. One patient, a 9-year old boy, was playing alone in his back yard, shot at a target and the paintball ricocheted back and hit his eye. Dr. Weishaar was able to re-attach the retina and the boy has "very good" vision. Most paintball eye injuries don’t end so well, though. In more than half of Dr. Weishaar’s cases, the eye’s resulting vision is 20/200 (legally blind) or worse. In one case, the patient had the eye removed. Keep the mask on Paintball EPDs have improved since the early ’80s when people mistakenly thought ski and shop goggles would suffice. In 1994, the American Society for Testing and Materials (ASTM) formed a task force to make paintball EPDs safer. Today, the Protective Eyewear Certification Council (PECC) is responsible for certifying that eye protection for many sports, including paintball, meets the ASTM standard.
"I don’t think (paintball) is a bad sport for kids," Dr. Vinger said. "It’s exciting, they like the game, they run around ... especially boys like aggressive activity." Dr. Vinger, however, worked within the ASTM to eliminate the use of fully automatic markers, which can fire 15 to 20 paintballs per second. He said manufacturers finally were convinced to stop their production because of the higher potential for blindness in both eyes and the risk of commotio cordis. More than meets the eye
In 1998, a 17-year-old was hit by a paintball while driving his car, lost control and crashed. In 2002, a 54-year-old skater also was hit by a paintball and suffered brain death after falling. While Dr. Laraque’s report doesn’t comment on the psychological implications of paintball, she said they are important to consider. "If you ask me personally, I would say ‘no, that I would not support the use of paintballs. It is a simulated war game and for other reasons I believe that children may be adversely affected in terms of aggressive behavior.’" Though the Academy has no official policy regarding children paintballing, Dr. Listman writes in this month’s Pediatrics that pediatric practitioners must be aware of both the popularity and danger of paintball activities. "I think the professional facilities, as long as they routinely require people to wear eye protection, are probably doing the best they can," Dr. Listman said. "The question is ‘can there be some more limitation on the availability of paintball guns to young people who are going to use them without taking the appropriate protection?’"
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