Snowball-associated ocular injury – An unusual presentation

Background: Snow ball associated ocular injuries are rare. We present the 1st case of a snow ball injury reported in India with symptoms occurring after 10 days. Purpose: To highlight the fact that symptoms can occur many days after the injury. The injuries can cause structural damage to ocular structures and can be permanent. Synopsis: A 25-year-old Asian Indian female presented with increased redness and blurring of vision of a day's duration. She had been playing in the snow and had an apparent injury to the right eye 10 days earlier. She had no symptoms at that point of time. Her uncorrected visual acuity by Snellen's chart was 20/20 in both the eyes. Intraocular pressure was normal in both the eyes. On evaluation of the right eye she had traumatic anterior uveitis and mydriasis and the left eye was normal. There was no evidence of posterior segment involvement. She was treated with topical steroids and her anterior chamber inflammation improved but she had persistent mydriasis with no effect on her near vision. She was subsequently lost to follow after a month. Highlights: Rare case of ocular injury caused by a hurtling snow ball. Demonstration of anterior chamber inflammation with a video Infrared video imaging of the pupil in bright and dark showing anisocoria worse in bright light. Protective goggles are a must while indulging in these activities. Video link: https://youtu.be/FpLbPTVg5Rk