A Blinding Occurrence

A Battery of Doctors Struggled to Understand What Had Gone Wrong With a Teen Athlete's Eyes

An avid hockey player since age 6, Lucio "Lou" Battista is no stranger to pain. "He has a very high tolerance," his mother, Liz Battista, said of her only child.

Last year while playing defense for his roller hockey team, Lou, then 15, was body-slammed from behind and hurled chest first into the board that separates the rink from spectators, then played two more games before realizing something was wrong. The blow was so forceful it fractured the hyoid bone in his neck, tore his esophagus and forced air into the space in the chest between his lungs, endangering his heart. He spent five days in the hospital and has fully recovered from injuries that could have been fatal.

But that experience, he said, paled in comparison with his ordeal last May, when he developed eye pain so searing it literally made him weep.

"It was unbearable," recalled Lou, a high school senior in Hopewell Junction, N.Y., who will turn 17 in two weeks. Unlike the hockey injuries, which were diagnosed quickly, it took doctors a week to figure out the reason for the stabbing pain and why his left eye went from 20/20 vision to being legally blind in a matter of days.

His doctors were baffled in part because an array of sophisticated tests -- CT scans, MRIs, a spinal tap and extensive blood work -- were all normal. It was a pediatric neurologist, the second he had seen, who quickly diagnosed the problem and within hours initiated treatment that stopped the pain and restored his sight.

Lou's problem began Friday, May 11. He awoke with a slight headache. Both his eyes were light-sensitive, but he didn't think about it -- he had too much to do. He had recently been inducted into the National Honor Society, was studying for an exam required for graduation and was preparing to be inducted into a technical honor society for his culinary skills. Along with ice and roller hockey, food is his passion, and he hopes to become a professional chef.

The headache worsened over the weekend, and over-the-counter pain relievers didn't help. By Monday, both eyes still hurt, but he popped some Advil and went to school.

Liz Battista had just arrived at work when her son called from the school nurse's office. "He'd left chemistry and told the nurse, 'I can't even think straight, the pain is so bad,' " she recalled. As Battista hurried to pick him up, she called their longtime pediatrician, Herschel Lessin. "Dr. Lessin told me, 'Get him over here right away.' "

It was the first in a series of medical appointments and tests that yielded possible diagnoses: ophthalmic migraine, head injury, brain tumor, meningitis, multiple sclerosis, even Lyme disease.

"I got really scared driving around from doctor to doctor," Liz Battista recalled. "It was go see this one, go see that one."

Lessin examined Lou, ordered an immediate CT scan of his head and referred him to a pediatric neurologist. After the CT scan, an MRI and blood work that the neurologist ordered all came back normal, he told Liz Battista her son had an ophthalmic migraine, which typically goes away after a few days. He sent them to an ophthalmologist, who agreed. The eye doctor also observed that one of Lou's optic nerves was enlarged, but said it was not a cause for concern.

By Wednesday, after a long, tense day that Lou spent in bed and in pain, he told his mother he couldn't stand it any longer. The pain was concentrated in his left eye, and he could see only shapes. His mother immediately called the neurologist, who told her he didn't know what else to do, and advised her to call the pediatrician.

Lessin's office told her to take Lou to an emergency room.

Doctors there gave Lou a shot of Demerol, agreed that it was an ophthalmic migraine and after 5 1/2 hours sent him home with painkillers.

The next two days were an uneasy waiting game. The family's optometrist told Liz Battista he didn't believe it was a migraine because it had lasted so long. A second ophthalmologist advised them to wait it out.

But Lou told his mother the painkillers were barely working. He said he felt they were masking what was wrong and he didn't understand why no one could figure it out.

"It was upsetting," Lou recalled. "Some of these really good doctors didn't know what to do. It was more tests and bloodwork and needles -- and we weren't getting anywhere."

On Friday, a week after the pain first surfaced, Lou woke up with the usual symptoms -- pain, light sensitivity -- but he could see almost nothing out of his left eye. His mother took him back to the pediatrician. Unable to reach the first pediatric neurologist, Lessin called a second one: Cecile Fray, who agreed to see Lou immediately.

Fray examined him and sent him for an immediate MRI of his eyes, head and neck. It was normal. Then she told the Battistas the problem was not a migraine. She thought Lou had either optic neuritis or a juvenile form of multiple sclerosis.

"I was pretty sure it was optic neuritis," Fray recalled, "but we had to see what the spinal tap showed." Lou had the swollen optic nerve sometimes seen in optic neuritis patients, and his pupils paradoxically dilated in response to light, another telltale sign. His spinal fluid was unaffected; a pediatric specialist who saw Lou a few days later ruled out MS and concurred with Fray's diagnosis.

Optic neuritis is an inflammation of the optic nerve, a bundle of fibers in the eye that transmit visual information to the brain. Its twin hallmarks are eye pain and vision loss. Some cases are caused by MS or a viral infection, but often the cause is unknown, according to the Merck Manual. Treatment with intravenous steroids has been shown to speed recovery of vision, which can take as long as two years, and may reduce the chance of a recurrence.

Fray immediately started him on high doses of intravenous steroids, and stayed with him until 3 a.m. Saturday after he had received the first dose. Within a day or two, the pain was gone and his vision returned.

"The care she provided was amazing," Liz Battista said. "If she was not in the hospital checking on his condition, she was on the phone following up."

Fray said she is still following Lou closely. He recovered faster than doctors expected: Five weeks after his hospitalization, his vision was measured at 20/20.

He is playing hockey again, works as a lifeguard three days a week at a health club, and last week learned he had been accepted to Johnson and Wales University in Providence, R.I., his first choice for college.

"I see him healthy, I see him back playing hockey six days a week, I'm grateful that he's back to his old self," his mother said. "Lou's attitude is 'Okay, I'm over this. Let's move on with life.' "

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