fencing, saying there are almost no eye injuries infencing, but if you take the mask off, you're at highrisk.

"I don't think (paintball) is a bad sport for kids," Dr.Vinger said. "It's exciting, they like the game, they runaround . .. especially boys like aggressive activity."

Dr. Vinger, however, worked within the ASTM toeliminate the use of fully automatic markers, whichcan fire 15 to 20 paintballs per second. He said man-ufacturers finally were convinced to stop their pro-duction because ofthe higher potential for blindnessin both eyes and the risk ofcommotio cordis.

_1 ~~~~~~~~~~~~~~~~~~~9dJROO1"

by Greg McConnellEditorial Intem

(EPDs), paintball injuries have increased in recentyears because a growing proportion of games arebeing played in unsupervised settings, according to astudy in the January Pediatrics.

which is why they represent most of the ocularinjuries. In addition, a dispropor-

_ ~~tionate number of injuries aremaoccurring in the pediatric popula-

_ ~tion (Listman DA. Pediatrics.2004;113:e15-e18).

; "Wh~~~atI ithink is happening is thiat_ ~~~adults who (play paintball) go out

0 ~~~with their businesses to centers

Dr.Lisnan where they require you to wear eyeprotection," said study author

DavidA. Listman, M.D., FAAP. "Children, though, playin the backyard, in the woods and . .. they're often notgoing to take the appropriate protective measures."

Howthe game is playedPaintballs are small gelatin capsules flled with non-

toxic, water-soluble paint. They are fired at 300 feet persecond from a CO2-powered marker, a.k.a. paintballgun, and splatter on impact. If a paintball hits thebody, often nothing more than a sting or small weltoccurs. However, since a paintball is small enough tostrike the eyeball, the resulting ocular injuries can besevere.As paintball grows in popularity, more questions

are being asked about the sport and its risks. Noteveryone, however, agrees on the answers. Some saypaintball simulates war and can encourage unhealthyaggression, 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. Twoteams try to capture each other's flag, while refereesofficiate and oversee proper use ofEPDs.However, since major sporting goods retailers sell

paintball markers to anyone over 18 years ofage, morehouseholds have access to the equipment to play thegame in unsupervised settings. Ocular injuries tend tooccur during this "backyard" play.

Nature ofeye injuriesPaulWeishaar, M.D., an ophthalmologist inWichita,

Kan., sawhis first paintball ocular injuryin 1998. Sincethen, he has had about 15 cases -all males. Most of

his paintball patients have been 17_ ~~~years and under, though he has yet

: _Y ~~to have one come from a commer-_ - ~~~cial paintball field.0 _ "~~~Iif(the paintball) doesn't pene-X_ t ~~trate the eye, they can have severe

blunt trauma consisting of hyphe-J ~~~~ma, iris tearing, cataract and retinal

Dr.eisaar hemorrhagic bruising (commotio)typically in the macula," said Dr.

Weishaar. "If it does penetrate the eye, frequently addi-tional injuries include corneal laceration plus, again,a traumatic cataract, the iris tearing and retinal

detachment, all ofwhich results in severe per-_manent visual loss."

D DrWeishaar has seen cases inwhich a personimistakenly thinks a game is over, takes his mask

offand gets hit. He also has seen cases inwhich not allof the players are wearing masks because there isn'tenough 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 rico-cheted back and hit his eye. Dr. Weishaar was able tore-attach the retinaand the boyhas "very good" vision.Most paintball eye injuries don't end so well,

though. In more than half ofDL.Weishaar's cases, theeye's resulting vision is 20/200 (legally blind) orworse.In one case, the patient had the eye removed.

Keep the mask onPaintball EPDs have improved since the early '80s

when people mistakenly thought ski and shop goggleswould suffice. In 1994, the American Society forTesting and Materials (ASTM) formed a task force tomake paintball EPDs safer.

Today, the Protective Eyewear Certification Council(PECC) is responsible for certifyingthat eye protection for many sports,including paintball, meets the

"It's safer to play paintball withprotection on at an accredited fieldthan it is to playbadminton inyourback yard," said PaulVinger, M.D., ; iprofessor of ophthalmology at _Tufts Medical School, PECC co- Dr.Vingerfounder and past president. He likens paintball to

More than meets the eyePaintballs also have injured people not involved in

games, according to Danielle Laraque, M.D., FAAP,former member of the AAP Committee on Injury,Violence and Poison Prevention and lead author ofan upcomingAAP technical report about nonpowdergun injuries, which includes paintball injuries.

In 1998, a 17-year-old was hit by a paintball whiledriving his car, lost control and crashed. In 2002, a 54-year-old skater also was hit by a paintball and sufferedbrain death after falling.While Dr. Laraque's report does- lt

n't comment on the psychological _implications of paintball, she said _Kthey are important to consider. "If_you ask me personally, I would say'no, that Iwould not support the useof paintballs. It is a simulated wargame and for other reasons I believe DrLaquthat children may be adversely

DrLaqu

affected in terms of aggressive behavior."'Though theAcademy has no official policy regard-

ing children paintballing, Dr. Listman writes in thismonth's Pediatrics that pediatric practitioners mustbe aware ofboth the popularity and danger of paint-ball activities.

"I think the professional facilities, as long as theyroutinely require people to wear eye protection, areprobably doing the best they can," Dr. Listman said."The question is 'can there be some more limitationon the availability of paintball guns to young peoplewho are going to use them without taking the appro-priate protection?"'

If you decide to let your child play paintball, here are some tips to reduce the risk of serious injury:1) Players should wear eye protection devices (EPDs) thatare specifically designed for

paintball and meet the ASTM Fl1776 standard.* EPDs that are not designed for paintball could be dislodged, or the lens/visorcould_be shattered or knocked into the eye. _

* Players should never remove their EPD during a game. Many players have been _hit in the eye while removing their mask to wipe off paint or clear up fogging. -

* Paintball EPDs with the Protective Eyewear Certification Council (PECC) logo 0'were tested by an independent laboratory and meet the ASTM Fl1776 standard.

2) Play at an insured commercial paintball field that voluntarily follows theASTM Fl1777standard for proper paintball field operation. -* Written parental consent should be required for anyone under 18 years of age. .* Proper barriers (such as netting) should separate the playing field from the spec- Pttator/rest area. Paintball rT

* Except during play on the field, barrel plugs should be used at all times to pre- ASTM Fl17vent markers from accidentally discharging. which is re

* Areas should be designated where EPDs must be worn at all times. the protecti* Fully automatic markers never should be used. from belov* Paintballs should not be fired at over 300 feet per second, and this is measuredby a chronograph on site. (There have been reports of concussions.)

* Referees should be present and able to enforce the rules, especially EPD use.

'hoto courtesy of www.protecteyes.org

nask certified by PECC to776. Note the chin strap,ecommended to help keeptor in place when impactedw.

January 2004 www.aapnews.org AAP News 117

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Proper equipment use in a supervised setting should be main objective

Prevent paintball injuries from hitting home