Author: Kaci Cunningham, DO
Co Author #1: Thomas L Pommering, DO, FAAFP
Editor: Christian Verry, MD
Senior Editor: Christian Verry, MD
Editor: Mandeep Ghuman, MD
A 20-year-old female Softball athlete presents with blunt trauma to her left eye.
During softball practice, a softball kicked up off of the lip between the infield and outfield, hitting her in the left orbit. An eye injury was immediately evident. She had eye pain, blurry vision and tearing. She denied double vision, foreign body sensation, photophobia and seeing flashes or floaters. A picture of the eye was sent to the team doctor who recommended immediate referral to a local ED Case Photo #1. She was treated in the ED but never saw an Ophthalmologist. The next day the team doctor arranged for a same day appointment with an Ophthalmologist. She was subsequently followed by the team physician weekly following her injury.
Initial Examination of her eye by Ophthalmology showed normal intraocular pressure and normal corrected visual acuity. Cornea and lenses were clear bilaterally. There were no iris abnormalities. Fundus exam showed an optic disc normal in size and color with a cup to disc ratio of 0.2. Vitreous humor was clear. Intraocular vessels were normal. No signs of retinal detachment.
Follow up exam by team physician 7 days post-injury showed minimal bruising and soft tissue swelling around her left eye. Her left eye showed a complete 360 degree, bulging subconjunctival hemorrhage. She was unable to completely blink her eye due to the hemorrhage. Her sclera was completely obliterated by the hemorrhage. There was no exudate Case Photo #2. Pupils were equal, round and reactive to light bilaterally. Normal swinging flashlight test. Extra ocular muscles were intact bilaterally. She had no deficit in visual acuity testing using the standard Snellen eye chart. Visual acuity was 20/15 right eye, 20/15 left eye, 20/15 both eyes.
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