A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

You'll put your eye out: Can the human eyeball be knocked out of the head?

April 15, 2005

Dear Cecil:

I just watched Oliver Stone's Any Given Sunday, which I thought was pretty good until somebody's eye got knocked out of their head. Literally. Has this ever really happened in football? If not, it seems gratuitous to have put this scene in the film. If so — GRROOOOOSSSSSS!!!

Cecil replies:

Certain parties are now thinking: This is one realm of knowledge where I'm content to leave my ignorance intact. Buck up, muchachos — at least I'm going to spare you the color photos. Although I couldn't find an instance of an eye knocked out while its owner was playing football, accidents of this sort do happen, sometimes due to surprisingly little force. In Anomalies and Curiosities of Medicine (1897), George Gould and Walter Pyle report several cases of what they call exophthalmos, protrusion of the eye from the orbit, or socket:

  • One man, upon getting up in the morning, blew his nose so violently that "to his horror his left eye extruded from the orbit. With the assistance of his wife it was immediately replaced and a bandage placed over it." Afterward the eyelid was swollen but apparently there was no permanent damage.
  • In some other cases, eyes popped out following vomiting or excessive coughing.
  • One fellow, "during a fire, was struck in the right eye by a stream of water from a hose, violently thrusting the eye backward. Contracting under the double influence of shock and cold, the surrounding tissues forced the eyeball from the orbit, and an hour later [the doctor] saw the patient with the eye hanging by the optic nerve and muscles. Its reduction was easy, and after some minor treatment vision was perfectly restored in the injured organ. Thirty months after the accident the patient had perfect vision, and the eye had never in the slightest way discommoded him."

Maybe folks were tougher in the old days. Or maybe Gould and Pyle didn't fully understand the injury they were describing. Whatever the case, the chances of full recovery after having an eye knocked out nowadays are slim — and I bet they weren't so hot in 1897, either. Doctors distinguish several conditions, some offering markedly better prospects than others: In traumatic globe luxation the eye is jolted far enough out of its socket for the eyelids to close behind it, but the eye muscles and optic nerve generally remain intact. This injury is plenty serious, but often skillful medical treatment can restore normal sight. In contrast, in traumatic avulsion of the globe the muscles and optic nerve are partially or totally severed, usually because the eye has been knocked completely out of the socket — your classic eyeball-hanging-by-a-thread horror story. More cases:

  • A 17-year-old boy had his right eye knocked out when he flew through the windshield following an auto accident and landed on the pavement 20 feet away. With difficulty surgeons put the eye back in the socket, but vision was gone and eventually the eye had to be removed.
  • A 38-year-old drunk … well, even those hardened of stomach probably don't need to hear about this guy, a recipient of a martial-arts blow who subsequently walked into the ER carrying his left eyeball. Suffice it to say that if the eye is fully avulsed, visionwise you're generally SOL.
  • A 30-year-old man known for his bulging eyes was involved in a car accident that left him with his right eye protruding, the lids partially closed behind it, and bone fragments in the socket. Surgeons cleaned out and repaired the damaged orbit and eased the eyeball back in. A few months later the patient had normal vision in both eyes.
  • A five-year-old boy fell on his face, causing luxation of one eye — the globe was still basically in its socket, but the lids and lashes were completely hidden behind it. After administering local anesthetic doctors pulled the lids forward and pushed the eye back into place. Three months later vision was normal. Two similar incidents occurred in Zambia following minor trauma — a 27-year-old man fell on his face and a 14-year-old girl was struck on the forehead by a swinging window. Same treatment as above; vision returned more or less to normal.

Some people are more prone to problems like this than others, mainly those having shallow eye sockets, loose eye ligaments, and so on; being a bit pop-eyed can't help, either. Folks of African descent are said to be at greater risk. Incidentally, Gould and Pyle go on to relate that "in former days there was an old-fashioned manner of fighting called 'gouging.' In this brutal contest the combatant was successful who could, with his thumb, press his opponent's eyeball out." Imagine what Oliver Stone could do with that.

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