Hello and welcome to Case of the Day! I’m Dr. Jim Croley and I’d like to welcome you here. We always, at the end of the day, sort of discuss an interesting case that we saw this day in the office and so today’s a really interesting case.
A gentleman comes in, around age 40, who decided to improve his golf swing so he bought one of these at home gadgets where I guess there’s a net, where he hit a golf ball in the net, maybe a video camera and so it was sort of a self analysis system for his golf swing. I guess he got tired of hitting the little styrofoam or sort of NERF kind of balls and instead went to, I think, to one of the stores and did buy a golf ball but something that was a lot more solid than the NERF ball that he was hitting because I guess, maybe he liked the sound of hitting it or maybe this guy is more fond to hit something hard so he bought this ball and unfortunately, as he’s practicing on his golf swing, he misses the net, and hits the frame of the net and the ball comes back and hits him right in the eye.
So he comes in complaining of blurred vision, and pain in his eye. It turns out that his vision wasn’t that blurred. It was about 20/40 uncorrected and actually with a small amount of a minus prescription or minus lens. He’s still 20/20 in the eye but his pupil was now dilated and larger than his other eye and did not move very much when we shined the light in his eyes so his reaction, pupil reaction, was diminished, because actually the contusion of the golf ball in his eye had actually torn some of the muscles. So the muscles in your iris constrict and relax to make your pupil go up and down. These muscles had been torn just like pulling a hamstring in a sport. So these muscles had been torn slightly and that caused the pupil to be dilated and I could see with a microscope, the slit lamp, which is a microscope that we examine the eye with, little tears in his iris muscle.
His eye pressure was normal that day and he’s dilated, the eye examiner think his retina is normal. Because he has some very mild inflammation, we put him on a prednisone or cortisone eye drop to use four times a day.
He came back a week later which is today. And today he’s complaining of more blurred vision. His eyes are not as sore and feels better but his vision’s now up to about 20/60 and now he’s a minus 150 amount of nearsightedness or a Myo and still 20/20 vision, though. So evidently he may be having some spasm that’s causing his eye to be more nearsighted. Not really sure yet but that’s how it’s gonna pan out and his pupil actually calmed down and gotten better. His pupil is smaller and now reacting to light and so that part looked good. The inflammation has gone out of his eye but his eye pressure was now 38. Ten to 21, we sort of consider normal pressure, and now his eye pressure in his eye was 38.
There could be several reasons for his pressure to be upped, which could be: he may be developing secondary glaucoma due to his eye injury, which can occur from injuries. Usually that’s where the iris is torn away from its attachment to the inside of the eye and you get an angle recession. I did a Gonioscopy. It’s where we take a contact lens and put on those as mirrors so I can see the angle of where the fluid drains out of the eye and the eye that had the injury, it was a dark browned-eyed individual and there was a lot of pigment in the little meshwork that looks like cheesecloth where the fluid drains through, compared to his other eye. And so evidently the contusion of his ball had dispersed a lot of the pigment from his iris into his angle. And may be the cause, we’ll find out when things clear up a little bit better. Maybe it’s what’s causing his glaucoma.
So someone who has a significant eye injury actually is at risk of glaucoma from usually angle recession and so if you had a significant injury to your eye, you do need to be careful about getting your eye pressure checked because this glaucoma can show up years later actually. So he has yet to come back. We’re treating his eye pressure and I’m sure that’s gonna come down though I don’t know yet exactly whether this particular individual’s gonna end with a permanent secondary glaucoma or whether this is temporary elevation of his pressure.
Also people can get elevation of their pressure from using prednisone which we used to calm his eye down and some people are called steroid responders, which means their eye pressure goes up once they’re on either prednisone by eye drop or if they’re taking a prednisone or cortisone systemically, it can cause your eye pressure to go up. Or if you had an injection, say for a back or a knee problem, of cortisone. That can actually raise your eye pressure as well. So you need to know that one of the side effects of cortisone is a rise in your intraocular pressure and can also cause cataracts. So interesting case and unfortunately this gentleman hit his golf ball into the frame, hit back and hit his eye. I think, long term, most likely, he’ll be okay. Hopefully he will not end up with a permanent secondary glaucoma.
So if you have any questions, you can try to contact us through the website and I’ll be happy to try to answer those and you have a great day. May God grant you excellent vision and healthy eyes.