Bilateral ocular trauma following a game of tug of war

“Tug of war” is a popular recreational game often perceived as harmless. However, the intense physical exertion and competitive force involved may occasionally result in severe ocular trauma. We report an unusual case of bilateral ophthalmic injury following a tug-of-war accident in a 17-year-old boy who presented with diminution of vision in both eyes (OS > OD) and elevated intraocular pressure in the left eye after rope-related trauma. Detailed ocular examination revealed retinal dialysis in the right eye, while the left eye showed iridodialysis, traumatic cataract, angle recession glaucoma, and vitreous hemorrhage. The patient was initially managed medically, followed by staged surgical intervention. Prompt diagnosis and timely management resulted in satisfactory intraocular pressure control with good preservation of vision. This case highlights the potential for serious bilateral ocular injury associated with seemingly innocuous recreational activities and underscores the importance of early recognition and appropriate multidisciplinary management.