Ocular Injuries in Pickleball: Clinical Evidence, Injury Surveillance, Protective Technology, and Prevention - A Narrative Review

Pickleball participation has expanded rapidly, while evidence on ocular and orbital injury remains dispersed across case reports, emergency-department surveillance, computational modelling, and prevention research. This narrative review aimed to synthesize the epidemiology, mechanisms, clinical spectrum, management, and prevention of pickleball-related eye injury, with particular attention to injury-surveillance methods and protective technology. PubMed/MEDLINE, Google Scholar, publisher databases, reference lists, and authoritative safety documents were searched through July 17, 2026. Direct pickleball evidence was prioritized, and studies from related racket sports were used as indirect context. Reported injuries range from corneal abrasion and traumatic iritis to hyphema, angle recession, lens or intraocular-lens displacement, retinal tears and detachment, traumatic glaucoma, eyelid laceration, and orbital fracture. Mechanism estimates depend on case definition: direct ball impact predominates in detailed globe-injury reports and one manually reviewed surveillance analysis, whereas broader eye, face, and head datasets identify a larger contribution from falls and paddle contact. Finite-element modelling supports the plausibility of damage to the angle, zonules, vitreous, and retina, but current models remain simplified. Dedicated protective-eyewear use is limited, and direct effectiveness data in pickleball are unavailable. Prevention therefore requires a combined approach involving certified eyewear, acceptable product design, player education, facility practices, and improved exposure-based surveillance.