Author: Sean Bradley, MD, CAQSM
Co Author #1: Scottie Patton MA, ATC
Senior Editor: Rahul Kapur, MD
Editor: Jillian Sylvester, MD

Patient Presentation:
A 21-year-old male collegiate football athlete presented to the training room with 3 days of progressively worsening blurred vision and pain in his right eye.

History:
He reported that over the previous three days he had experienced worsening blurry vision, painful eye movements, and difficulty differentiating between colors. He denied headaches, photophobia, or double vision and had never experienced vision issues prior to this event. He had never used glasses or contacts. His past medical history was significant for well-controlled Attention Deficit Hyperactivity Disorder for which he was prescribed Adderall 30mg XR daily.

Incidentally, he was a restrained driver in a motor vehicle accident 2 weeks prior to his presentation to the training room, noting he struck his head but did not lose consciousness. There were no other injuries associated with the accident. His vision issues started approximately 10 days after this accident.

Physical Exam:
Training room exam:
GENERAL: Well appearing, in no acute distress. Alert an oriented to time, place, and person.
HEENT:
Right Eye: pupil exhibited a slow pupillary response. Extra-ocular muscle motions were in-tact, but with notable pain with adduction and supra-adduction. No conjunctivitis or scleritis noted. Visual field testing was grossly intact and symmetric, but with subjective blurry vision. Unable to count fingers beyond 2 ft with the right eye (Photo 1).
Right Funduscopic exam: Patton lines with 3+ optic disc edema (Photo 2).
No erythema in posterior pharynx.
Neuro: Cranial Nerves 2-12 intact. 5/5 strength in upper and lower extremities, sensation and reflexes grossly intact.

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