Sir,

The risk of injury in extreme motorcycle racing is well established.1, 2 We report two cases of ocular injuries to spectators without eye protection.

Case report

A 14-year-old boy (patient A) sustained blunt trauma to the left eye, caused by a small stone sprayed by a passing racer while at a motocross race. Visual acuity (VA) was 1.0 logMAR in the left eye. Examination showed anterior dislocation of the lens with mild vitreous haemorrhage. A vitreolensectomy was performed and the patient is awaiting a secondary anterior chamber lens implant. Fundoscopy revealed a choroidal tear temporal to the optic disc with pigment stippling at the macula (Figure 1). Corrected VA in the left eye is currently 0.6 logMAR.

Figure 1
figure 1

Patient A: (i) Left eye, traumatic anterior dislocation of the crystalline lens. (ii) Post-traumatic left choroidal tear temporal to the optic disc with pigment stippling at the macula.

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A 50-year-old man (patient B) sustained blunt trauma to the left eye by a mechanism similar to the above case. VA at presentation was 0.5 logMAR in the left eye. He had a hyphaema and superior iridodialysis. Fundoscopy revealed a traumatic retinal dialysis with an associated nasal (macular attached) retinal detachment (Figure 2). He underwent a left pars plana vitrectomy, encirclement, 360° endolaser, and gas tamponade with 20% C2F6. Post-operatively he developed an epiretinal membrane with macular pucker and cataract. Present vision is 0.9 logMAR in the left eye and he is awaiting cataract surgery. The patient was a heavy goods vehicle (HGV) driver and the injury and visual loss have resulted in the removal of his HGV licence.

Figure 2
figure 2

Patient B: left eye, nasal traumatic retinal dialysis-related retinal detachment.

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Comment

Motocross takes place on an outdoor track containing natural terrain with human-made obstacles. Injuries among riders in the sport are high. Even paramedical staffs attending to the injured racers on track are advised to wear eye protection because of the risk of sprayed debris from the passing racers.3 Although neutral zones outside the track provide safe run-off areas for riders and their machinery to minimise the potential risk of the injury to the spectators,4 our cases highlight the risk of ocular injury from flying debris even at these distances. Many spectators are ‘one-off’ visitors to these events and are not expecting to sustain ocular trauma with the potentially life-changing consequences. We recommend that spectator safety should be improved by offering eye protection.