Increased severity of ocular and oculofacial injuries in major league baseball after implementation of a pitch clock.

Purpose: Ocular and oculofacial injuries in baseball can lead to significant morbidity, particularly from high-velocity impacts. In 2023, Major League Baseball (MLB) introduced a pitch clock to accelerate the pace of play. This study evaluates whether these rule changes influenced the frequency and severity of oculofacial injuries among MLB players.

Methods: A retrospective analysis was conducted on MLB players who sustained ocular and oculofacial trauma resulting in missed games between the 2019 and 2024 seasons. Injuries were categorized anatomically and assessed for association with pitching. Injury severity was measured by the number of days missed. Statistical comparisons between pre-rule (2019-2022) and post-rule (2023-2024) periods were performed using Mann-Whitney U, Chi-square, and Kruskal-Wallis tests.

Results: Fifty-six injuries were analyzed. Injury frequency did not significantly change between the pre-rule (8.25 injuries/season, SD  ±  2.95) and post-rule periods (11.5 injuries/season, SD  ±  1.50; p = .481). Pitching-related injury severity increased significantly, with time missed rising from 3.25 days/injury (SD  ±  4.89) pre-rule to 34.64 days/injury (SD  ±  73.10; p = 0.001). Periorbital injury severity also increased from 3.31 days/injury (SD  ±  5.09) pre-rule to 42.40 days/injury (SD  ±  84.98; p = 0.005).

Conclusion: While the frequency of oculofacial injuries remained stable, the severity of pitching-related injuries significantly increased following the rule change. Reduced recovery time between plays may contribute to higher-impact trauma. Further investigation and enhanced protective measures are warranted to mitigate potential safety risks.