Dear Editor,

In this retrospective epidemiologic study, the National Electronic Injury Surveillance System (NEISS) was utilized in order to evaluate emergency department visits related to ocular injuries that occurred at school in children ages 5–18 between 2000 and 2019 in the United States. Though home is the most common locale for pediatric ocular injury [1], the school is the second most frequent setting. The study highlights the consumer product related ocular injuries seen at school, which can serve to identify and mitigate the threat of such items by educating students and formulating interventions such as the use of safety goggles during certain sports activities.

Between 2000 and 2019, an estimated 127,838 ED visits for school-associated ocular injuries in children were identified of which 54% (69,163) were in the middle and high school age group, 12–18 years, and 46% (58,765) in the elementary school group, ages 5–11. Overall, 83,966 children (65.7%) were males accounting for 61.6% of injuries in the younger group and 69.2% in the older group.

The majority of patients (98%) were released to home from the ED with ocular contusion being the most common diagnosis (69,350, 54.2%). Other diagnoses include ‘other’ (24,487; 19.2%), foreign body (9100; 7.1%), and dermal/conjunctival injury (8747; 6.8%). An estimated 558 (0.4%) patients with ocular injuries were admitted to the hospital.

Most ocular injuries at school were sport-related (46,177; 36.1%) followed by pens/pencils (20,833; 16.3%), workshop equipment (12,035; 9.4%), paper products (8152; 6.4%), and detergents and chemicals (7941; 6.2%). The breakdown of injuries by product category per age group and sex are shown in Table 1. Basketball was the most common sport associated with ocular injuries at school in both age cohorts with other sports shown in Fig. 1.

Table 1 Estimated number of ocular injuries at schools in the US between 2000 and 2019 caused by the most common product categories by age cohorts and gender
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Fig. 1
figure 1

Estimated number of pediatric ocular injuries in the US per sport for each age group between 2000 and 2019

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Among children in the older cohort (ages 12–18) sport-related injury comprised 43% of all injuries. Most of the eye injuries among younger children (ages 5–11) were related to either sports (28%) or pens/pencils (25%). Approximately 1/3 of all injuries in both males and females were sport-related. Males had a higher proportion of workshop-related ocular injuries compared to females (12% to 4%), but females had a higher proportion of injury with pens/pencils than males (21% vs 14%). Though most ocular injuries at school that presented to the ED were discharged to home after treatment without hospitalization, they were deemed serious enough to mandate medical care in the ED, thus consuming time and resources from parents and school authorities. These findings can be utilized by school faculty/administration to guide supervision during in-school activities and play an important role in teacher and student education regarding potential causes of harm in the classroom depending on specific age groups.

The overall yearly frequency of pediatric eye injury decreased over the last two decades 2000–2019 [1]; similarly, ocular injuries at school has also shown a decreasing trend with an estimated 7740 injuries in 2000, 7078 in 2010 and 4113 in 2019. The average annual number of pediatric eye injuries for the past decade (2010–2019) was 63,658, while the average annual number of eye injuries at school for the same time span was 5859. Continued efforts are needed to prevent ocular injuries in the school setting. Regulatory bodies such as the American Academy of Ophthalmology have released guidance on specific types of goggles for use for children during sports activities which hopefully will assist to formulate safety measures at school [2, 3].

Limitations of this study are as follows. NEISS provides information for ocular injuries presenting to the ED but does not capture injuries managed at home, in urgent care settings, with community ophthalmologists and primary care physicians that can underrepresent the true frequency of pediatric ocular injury. Injuries not associated with consumer-products or vague descriptions of injury related to products were not included in the study that also could underscore the frequency of injuries.