T Nation

Halos/Blurry Vision After Heavy Squat Triple


#1

Yesterday I was doing heavy squat triples in preparation for a powerlifting meet. I worked up to 595 for 3 with a belt and knee wraps. The 2nd and 3rd reps were grinders. This is 15 pounds better than my previous best triple.

When I took off the belt and wraps it seemed like my glasses were fogged over. I took my glasses off and the room looked like I was in a steam room. All the lights also had halos around them. I looked in the mirror and my eyes were bloodshot and I had small red dots (petechia) on my bottom eyelids. The blurriness started improving slowly and was gone after about 30 minutes. During this time I had no headache, dizziness, eye pain, numbness, or weakness.

Has this ever happened to any of you before?


Intra-Occular Pressure and Deads ?
#2

How was your vision immediately before this set? What I’m asking is, was there any hint of fogginess prior to this last set?

Has anything like this ever happened before? Even if it was mild/barely noticeable.

Are you nearsighted (ie, without glasses you can see up close, but stuff at distance is blurry)?

Given the amount of weight you were lifting, I assume you’re male. How old are you?


#3

My vision was fine before the set. I’ve never had anything like this before although in the past I’ve had problems with halos around lights at night but that improved with new glasses. I’m a 37 year old male and I am nearsighted. My blood pressure was checked at the gym and was 137/72. It’s been a while since my last eye exam but I’ve always had good intraocular pressures and no retinal problems.


#4

Let me start by saying that, while I am an ophthalmologist, I’m not YOUR ophthalmologist. So the only medical advice I can/will give is to urge you to get an eye exam with an ophthalmologist (not an optometrist), and to do so sooner rather than later.

Now my thoughts re what happened. The symptoms you describe–steamy vision with halos around lights–are classic for corneal edema. The cornea is the ‘dustcover’ of the eye; it’s the transparent domed structure on the front. Behind the cornea is a fluid-filled space called the anterior chamber (AC). The fluid in the AC is always leaching into the cornea, but the inner surface of the cornea is lined with specialized endothelial cells that pump the fluid out of the cornea and back into the AC. Corneal edema occurs when the endothelial cells can’t pump the fluid out as fast as it’s leaching in. As the cornea becomes edematous, it becomes hazy (causing the steamy vision) and the surface becomes irregular (causing halos around lights).

There are two main reasons why the endothelial cells are unable to pump dry (the formal term is ‘deturgesce’) the cornea:

  1. There is a problem with the endothelial cells themselves; ie, they are abnormal and/or too few in number; or
  2. the endothelium is normal, but the intraocular pressure (IOP) is so high that fluid is entering the cornea at a rate at which even normal endothelial cells can’t pump it out fast enough to keep the cornea from becoming edematous.

So, what’s going on with your eyes? Only a slit-lamp exam can say for sure. That said, and for a number of reasons, my suspicion is that yours is an IOP problem, possibly a condition called Pigment Dispersion Syndrome/Pigmentary Glaucoma. The classic PDS/PG pt is a young (20s-30s) myopic white male; the classic complaint is blurry vision and halos induced by exercise. (The Magic Google Box will reveal all sorts of info about PDS/PG.)

tl; dr See an ophthalmologist as soon as it is convenient to do so. If you wouldn’t mind providing a follow-up note after you’re seen/evaluated, I’d love to hear what your eye dentist had to say.


#5

Thanks, that makes a lot of sense. I’m an internal medicine doctor myself but don’t know much more than the basic ophthalmology.


#6

Ah. That explains the concision and precision of your post, the inclusion of pertinent negatives, and use of the word ‘petechiae.’ Best of luck, doc.


#7

I will make an appointment with an ophthalmologist as soon as their offices reopen after the holiday. I tried earlier today but they were closed.

In retrospect I think I’ve had very very minor symptoms of blurriness for a while now, like the last 10 years or so. I usually just thought it was some gunk in my eye. My last eye exam was in early 2012 and my IOP was normal.

I’ve never had anything before like what happened yesterday though. I’ve been doing strength sports since I was 13 years old and have strained lots of times in the past. I think that triple yesterday was possibly the hardest lift I’ve ever done in my life. I’m planning on going for a 700 pound squat at a meet in January and I’ve been looking ahead to this week for a while now, telling myself if I can get this 595 triple I can get the 700 at the meet. So I didn’t feel super strong after I did 545 for 3 but I did it anyway and ground it out.


#8

I’ve seen spots before from squatting. My eyes regularly go red and bulge from their sockets when I approach my max as my blood pressure shoots through the roof holding my breath to stay tight.

I also managed to burst a blood vessel in my right eye last week doing squats. I didn’t even realise, as it wasn’t immediately obvious and I went home from the gym, showered, ate and went to bed, then never caught my reflection properly the next morning to see it. It wasn’t until one of the lads at work commented my eye was looking very bloodshot that I saw the full extent and it gradually spread over the day and then started to subside the next day. I had another crack at squats and as I approached my max my right eye went noticeably achey so I left it be, not wanting to do a Ryan kennelly and have my eyes burst.


#9

I got an appointment with an ophthalmologist on the 31st. I won’t be doing any near max grinders between now and then.


#10

Hope all is ok pal.

Here is a pic of my eye after it tried to pop


#11

Discobolus, I’ve been thinking a lot about your post (as you might imagine, it piques my interest both professionally and personally). Unfortunately, there is scant literature concerning weightlifting and IOP, and no studies (that I could locate) looking at squats specifically (much less the extreme sort of squatting you perform).

Our understanding of IOP dynamics is represented by what is known as the Goldmann equation:

IOP = Episcleral venous pressure + (aqueous formation rate)/(aqueous drainage facility)

Aqueous drains from the AC into the episcleral venous plexus, which in turn drains into the cavernous sinus via the superior ophthalmic vein (this is a somewhat streamlined/simplified description, but captures the important points). In theory, episcleral venous pressure (EVP) equals central venous pressure (CVP). Note that the Goldmann equation predicts IOP should change mmHg-for-mmHg with changes in EVP (and therefore CVP). However, we know this is not the case, and that IOP is to some degree independent of EVP. For example, there are clinical conditions in which IOP falls below EVP, which (per the Goldmann equation) should not be able to happen. Likewise, the limited research concerning weightlifting and IOP found that, for most of the individuals studied, IOP did not rise in 1:1 fashion with CVP, although CVP was not directly measured (for understandable reasons–no IRB is going to let you thread a Swan-Ganz catheter into individuals who then do a triple at 595#).

All that said, there are data suggesting that a subset of individuals do not autoregulate IOP as well as others. For example, a minority of the individuals in the weightlifting-and-IOP study experienced much higher IOP spikes than did the others. Similarly, there are case reports of horn players with glaucoma who were found to have significant spikes in IOP while playing (horn-playing requires generating and sustaining high intrathoracic pressures, with a concomitant increase in CVP). Likewise, there are case reports of yogis with glaucomatous damage attributed to sustained IOP spikes incurred while in the headstand position (presumably via increased EVP secondary to gravity-dependent impeded venous return).

All of this is to say, I’m wondering if you are one of the individuals who does not autoregulate IOP well during spikes in CVP/EVP. Maybe your ophthalmologist should go to the gym with you and measure your IOP while you squat. (Kidding. Sort of.)

Edited for clarity


#12

I saw the ophthalmologist last week and he dilated my eyes and did a slit lamp exam. He said everything looked totally normal and healthy on the exam. My IOP was 16 on the left and 20 on the right.

He didn’t really have an explanation for me for what happened outside of the type of bullshit answers doctor’s give patients when they don’t know what’s going on. He said something along the lines of “maybe it was a vascular event”.

Anyway, I’m doing the meet on the 31st and plan on going for a 700 pound squat. After that I’m cutting my training maxes down and will not be doing grinders for a long time.


#13

Well, you can take some comfort in the fact that you don’t have advanced glaucomatous optic neuropathy, which is what I had feared was going to be the case.

If you should experience a repeat event, consider asking someone there with you to look very closely at your eyes to see if your corneas look ‘steamy.’ (A layperson might only note that they can’t see the color of your eyes very well.) Note that for the corneal edema to be visible to the naked (and untrained) eye, it would have to be a significant event like the one you described in the OP. If your eyes do appear steamy, ask them to try and get a cell-phone pic of it (would be useful for your eyedoc to see).


#14

Hi disco, just bumping the thread to inquire whether your symptoms have recurred.

FYI, I ‘presented your case’ (via an online physician-only forum) to garner the thoughts of other ophthos. Thus far, a consensus opinion eludes us.


#15

No, it hasn’t happened again. I’ve done several AMRAPs over the last few weeks including deadlift of 505 for 6 today and squat 470 for 6 (no knee wraps) and had no problems. Those sets were strenuous but nothing like the 595 for 3 with knee wraps.