Author: Nicholas Douville, MD
Co Author #1: Peter Karagozian, MD
Co Author #2: Michele Kirk, MD
Co Author #3: Jason Mogonye, MD
Senior Editor: Siobhan Statuta, MD, FAMSSM
Editor: Brian Harvey, DO

Patient Presentation:
Patient presented to the sideline with vision changes and seeing a spot in her right eye after being struck in the face with a volleyball.

History:
20 year old collegiate women's volleyball player presents to the sideline after being struck on the right side of the face by the volleyball while attempting to block a spike at the net. The athlete was endorsing a red to black spot near the center of her vision that did not track with movement of her eyes. She noted some mild pain over the right side of her face where she was hit by the ball but no pain over the orbit itself. She denied any previous issues with her vision or similar symptoms in the past and had furthermore never required corrective lenses. The patient was able to continue playing but endorsed that the "spot in her vision" remained. She denied any headache, light headedness, dizziness, blurry vision, double vision, eye pain or any other associated symptoms.

Physical Exam:
General: Alert, cooperative, no distress.

Head, eyes, ears, nose and throat: Extra-ocular muscles intact bilaterally, pupils equal round and reactive to light and accommodation, no scleral/conjunctival injection, no tenderness to palpation over right
orbit, no evidence of developing hyphema, no flashes/floaters.

Cardiac: Regular rate and rhythm, no murmurs, clicks, or rubs.

Pulmonary: No respiratory distress, normal work of breathing.

Skin: No ecchymosis, erythema, edema noted on right side of face.

Neurology: Alert and oriented x 3, Cranial nerves II-XII intact bilaterally, normal gait.

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