Case History:
A 17 year old male comes into the clinic with a 7 day history of loss of vision in his right eye. He denies pain or other ocular irritation. Upon questioning he states that he was at swim practice a week prior when the swimmer in the adjacent lane got too close and during his stroke, hit the patient in the right eye with his finger. Prior to the injury, the patient had perfect vision in the right eye.
Review of systems is negative. His past medical and surgical history are non-contributory. He is not on any medications. Family history is non-contributory. He is a high school senior. He denies alcohol, tobacco and recreational drug abuse.
On clinical examination the patient is healthy, alert and oriented. His visual acuity is NLP OD and 20/20 OS. His ocular motility is full. Intraocular pressures are within normal limits. He has a 4+ relative afferent papillary defect on the right. The rest of the anterior and posterior segment examination is within normal limits with the exception of a mild subconjunctival hemorrhage on the right eye.
CT scans are reviewed which show intact orbital bones and the lack of any orbital hemorrhage. The scans are essentially within normal limits.
Diagnosis: traumatic optic neuropathy OD
The cause for loss of vision in this case is traumatic optic neuropathy. This occurred after blunt trauma when the opponent’s finger entered the orbital space, without penetrating through any tissues, and injured the optic nerve. The patient was unfortunately not wearing his goggles at the time. At this point in time, no treatment was indicated or recommended, as one week of NLP vision points to a very severe injury that is unlikely to recover. Steroids this long after the injury would likely not prove beneficial. On the other hand, high dose steroids immediately after the injury may have given the patient a chance at some visual recovery, but not guaranteed.
The case above is demonstration that a relatively benign, non-contact sport does not go without danger to the eyes. It is imperative that swimmers wear goggles to protect their eyes from not only potentially harmful chemicals in the water, but from trauma such as outlined above. Competitive swimmers, such as those in the current Olympic Games in Beijing, wear goggles at all times, primarily because it allows one to see clearly under the water, but also for protection.
The bottom line is: goggles are recommended while swimming, especially if competing in water sports, such as relays or water polo where opponents may come into close contact. Eye injuries, fortunately, are very rare during water sports, but as seen in the case above, can be devastating.
Good luck to the USA in the summer Olympics and GO MICHAEL PHELPS!!