Snow, Speed, and Sight

Winter sports are commonly associated with lower limb injuries, while eyes—frequently exposed to stress and risks—remain underestimated and need more recognition, according to Ruggiero Paderni MD.

Dr Paderni served as an ophthalmologist consultant at the Milan Cortina 2026 Winter Olympic Games, where he managed ocular emergencies for athletes and their families. The healthcare organisation for such an event was massive: a top-level healthcare system capable of ensuring safety and rapid response in every context, covering an area of more than 22,000 km² across Lombardy, Veneto, and the Autonomous Provinces of Trento and Bolzano and from metropolitan areas to high-altitude competition sites.

The designated Olympic hospital was the Niguarda Hospital in Milan, where an Olympic ward has been inaugurated with 11 inpatient rooms directly connected to the emergency room via protected tunnels. Some Olympic polyclinics were established on site, along with a well-coordinated collaboration with regional paramedics. Each competition venue had at least two medical stations (one for athletes and one for spectators) with dedicated protocols for rapid ‘on snow’ triage.

This network supported Dr Paderni’s efforts to protect eye safety, which he said is crucial in winter sports. Understanding ocular risks is essential for prevention, safeguarding visual function, and ensuring optimal performance during competition.

“The main risk factors in high-altitude mountain environments include high speed, atmospheric events like wind, cold, and UV radiation, and rapid altitude changes,” Dr Paderni explained.

High speed or physical contact sports—such as skiing, snowboarding, skeleton, luge, hockey, and ice skating—expose the eye to blunt traumas caused by collision with other athletes, accidental falls, or impacts with equipment. These injuries can lead to a sudden increase in IOP and permanent visual damage due to intraocular haemorrhages, retinal detachment, or vascular occlusions. Frontal impacts may also result in orbital fractures (blow-out), which can trap eye muscles and cause diplopia. Trauma may also be associated with potentially critical systemic conditions such as concussion (due to intracranial haemorrhage) and systemic infections (caused by lacerated wounds), which must be promptly managed to ensure the athlete’s safety.

Wind and cold can irritate and dehydrate the ocular surface. Moreover, wind may carry small debris that can penetrate the eyeball and cause corneal abrasions and infections. UV rays may cause damage to the cornea, such as photokeratitis, because snow reflects up to 80% of them, amplifying exposure. Altitude also plays a role, since UV intensity increases by about 10% every 1,000 metres. Extreme environmental conditions can alter ocular physiology, requiring the eye to adapt to atmospheric changes in pressure and oxygen levels: rapidly ascending from 500 to 3,000 metres may lead to temporary decreases in visual performance, and corneal hypoxia and high-altitude retinopathy are potential risks.

Helmets and goggles

For these reasons, protective equipment is essential to prevent irreparable damage to the eyes at high altitude. Helmets and goggles must meet strict standards, including UV-400 certification to block 100% of UVA and UVB rays; category 3 or 4 filters with polarized lenses to shield against radiation reflected from snow; shatterproof materials (polycarbonate or Trivex) to prevent splintering; and anti-fog systems with double lenses and a sealed air chamber to prevent condensation and maintain clear vision in extreme conditions.

As Dr Paderni remarked, the ophthalmologist assisting an injured athlete must be able to manage ocular emergencies by applying specific diagnostic and therapeutic protocols in accordance with accepted guidelines for immediate risk assessment. In ophthalmic emergencies, the guidelines of the AAO are typically followed. Also considered valid are the “Consensus statement on injury and illness in sport” by the International Olympic Committee (IOC), useful for assessing craniofacial injuries, and the “F-MARC Medical Assessment Guidelines” developed by FIFA during the 1994 World Cup, useful for immediate on-field evaluation of visual capacity.

Among the ‘warning signs’ requiring immediate ophthalmological evaluation are severe eye pain after trauma (indicating a foreign body or sudden increase in the IOP, especially if associated with nausea), photopsia, floaters, ‘curtain-like’ visual shadows (suggestive of retinal lesions), diplopia in orbital fractures, and altered pupillary reflexes or anisocoria. Photokeratitis presents with severe pain and burning, redness, intense tearing, and reduced visual performance (even for 24 to 48 hours).

Dr Paderni said he was lucky to face only some cases of conjunctivitis, which he believes were likely caused by foreign bodies, photokeratitis, and a corneal abrasion. More severe traumas were evaluated at the Niguarda Hospital in Milan. However, such an experience is really something unique and once in a lifetime.

“It was both a great responsibility and an honour,” Dr Paderni said. “Being part of such a complex international event gave me the chance to contribute to athlete safety while applying specialised medical expertise in a challenging and dynamic environment.”

Ruggiero Paderni MD is head of the neuro-ophthalmology service at the Centro Diagnostico Italiano, Milan, Italy. He was a member of the Olympic medical staff for the Milan Cortina 2026 Winter Olympics.