Case Report: Indirect Traumatic Optic Neuropathy from Sub-Concussive Soccer Headers in a 62-year-old Athlete.

SIGNIFICANCE: Traumatic optic neuropathy (TON) is an uncommon but devastating cause of vision loss following injury to the head. Soccer players may have a heightened risk due to the game's emphasis on heading the ball, a technique in which a player hits the soccer ball with their head.

PURPOSE: This paper reviews the case of an avid soccer player with traumatic optic neuropathy that occurred after numerous soccer ball headings during a game. This paper also (1) provides a summary of the pathophysiology and epidemiology of traumatic optic neuropathy, (2) reviews the current literature on head and eye injuries in soccer, and (3) discusses biomechanical differences in orbital structure throughout aging, which may predispose older patients to traumatic optic neuropathy.

CASE REPORT: We present the case of a 62-year-old male patient who reported to the clinic, following repeated sub-concussive soccer ball headers the previous day, with symptoms of blurred vision and "seeing stars" in the right eye and a right inferior visual field impairment. Physical examination, subsequent lab work, and neurologic consults implicated TON as the primary diagnosis, and halting soccer playing resulted in symptom improvement.

CONCLUSIONS: Though not commonly encountered in soccer players, the potential for TON exists. Older athletes may be predisposed due to morphological changes of the orbit. Future direction may look to further investigate hazards promoting traumatic optic neuropathy in older athletes and determine possible protections against injury.