Schoolyard Game Really Does Poke Eyes Out

Doctors report a water bottle fad that can really cause lasting eye damage.


June 23, 2008— -- When a 14-year-old girl showed up at the Lahey Clinic Medical Center in Peabody, Mass., last spring with a seriously injured eye, she could hardly see anything except for major hand movements.

"Basically, she had an eye full of blood," says ophthalmologist Shiyoung Roh.

Without treatment and surgery, Roh says the building pressure from the wound would have likely left her blind in that eye.

Although the girl's 20/20 vision eventually returned, the eye trauma she sustained will likely cause early cataracts.

The cause of the trauma: a seemingly harmless, thin plastic water bottle.

As any older parent will tell you, adolescents can make a dangerous game out of the most mundane household items -- from using sleeping bags to slide down stairs to mixing an explosive concoction of Mentos and Diet Coke.

According to the New England Journal of Medicine, the humble plastic water bottle is the latest in the parade of household objects gone bad.

Coincidentally, Roh had heard her 9-year-old son describe the water bottle trick just a few weeks before she saw her first injured patient.

"There's a particular water bottle now that's softer, that has little twists in it," says Roh. The game: Loosen the cap, twist and twist the thin center of an empty water bottle and ... voila, a high-pressure water bottle cannon.

"When you bang the bottom with the bottom of your hand, then the cap shoots off," says Roh.

Roh says the 14-year-old girl she treated, who was unnamed in the report, just happened to be in the line of fire.

"It's amazing the amount of force that had, in order to cause the amount of damage that it did," Roh says.

Ask emergency room doctors around the country, and they may not have heard this particular story. But they likely know of the local dangerous fad -- water bottles in Massachusetts, soda bottles in North Carolina and creative firework manipulation everywhere else.

Dr. Benjamin Shain, head of the division of child and adolescent psychiatry at Evanston Northwestern Healthcare in Evanston Ill., studies what motivates adolescent self-destructive behavior.

"In junior high school age, there's a general sense of need for conformity," says Shain. The conformity can be in adopted behavior or clothes, and it oftentimes spans an entire school, whether all the children are friends or not.

"And so the whole peer group is very important, even if you're not in a single group," says Shain. "In the early teens, it's much stronger. Then, at age 18, 19, 20 it starts diminishing."

In those crucial early teens, a few factors can influence whether a teen will be more apt to follow the dangerous fads -- like the choking hold or lying down in traffic -- along with more benign ones.

One influence could be the family. Shain says children who feel closer to their peer group than to their family are more likely to conform. Individual characteristics -- like aggressiveness -- can also increase the tendency to seek thrills, as can behavioral or mental issues.

Shain says a child with bipolar disorder might feel grandiose, like nothing can injure them. Children with attention deficit hyperactivity disorder may also be more likely to undertake thrilling risks.

"With ADHD, the brain needs a lot of stimulation to feel anything," says Shain.

However, Shain emphasizes that all adolescents -- and many adults -- can be susceptible to the fad phenomenon.

"Every age has its own developmental stuff going on," says Shain. "It's not like all of sudden as a teenager you become an alien and you become a person again."

Dr. Bret Nicks of the Department of Emergency Medicine at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., certainly feels like a different person than he was as teenager.

"We did things, things that are just insane," he says. "And of course, now I wouldn't even let my kids know what they were or how to do them."

The U.S. Centers for Disease Control and Prevention lists not wearing helmets, not wearing seat belts and alcohol-related car accidents as the top causes of accidental injury; social games tend to appear pretty far down the list. But while Nicks says the majority of injuries he sees in the hospital are related to everyday falls, summertime always shows an increase in mischievous fads.

Nicks has even seen the water bottle game before.

"There's multiple ways that can be done," says Nicks, who says soda bottles, heated in the hot summer sun, can also turn into an improvised projectile weapon.

"But the most common one -- from a force perspective -- would be a paper clip," says Nicks. He's seen kids pelted in the eye from paper clip rubber band slingshots, as well as clever pen projectiles made by rearranging the spring and plastic parts from click pens.

"A lot of those games really just come out of curiosity," says Nicks, who thought it was out of the ordinary for the 14-year-old to be seriously injured in the water bottle game.

So perhaps mothers won't have to take bottle caps away from their teenagers as well as their toddlers, after all.

"There's appropriate prevention -- helmets and elbow pads -- but even still injuries can occur," says Nicks. "There's not a lot you can do about those."