Nandrolone (19-Nortestosterone) is an androgenic-anabolic steroid, known to increase muscle mass and strength, thereby enhancing sporting performance, in injectable or oral presentation (Lambert and Gibson, 1995). The metabolites of Nandrolone are 19-Norandrosterone (19-NA), 19-Noretiocholanolone (19-NE) and 19-Norepiandrosterone. Their urinary detection by gas chromatography-mass spectrometry, forms the basis of doping. Nandrolone still has therapeutic use in specified disease processes, including osteoporosis, but is rarely used (BNF, 2009). The International Olympic Committee (IOC) prohibited its use in sport in 1976. A doping offence occurs when the critical concentration for Nandrolone metabolites in the urine exceeds 2 ng/ml. In a doping control situation, the excretion kinetics of labelled Nandrolone, show inter-individual variability, in 2 individuals treated with the same dosage at the same time (Baume et al., 2004). An international athlete recently presented with metabolites of urinary Nandrolone >2 ng/ml. There was a variation in levels in A (19-NA: 6.2 ± 0.18 ng/ml; 19-NE: 2.6 ± 0.08 ng/ml) and B (19-NA: 5.6 ± 1.1 ng/ml; 19-NE: not measured) samples. The medico-legal defence prepared a defence: that he had been prescribed “Keratyl” eye drops (containing Nandrolone sodium sulphate) for an anterior uveitis and corneal abrasion. A WADA-accredited laboratory study administered therapeutic levels of Keratyl eye drops to subjects which produced positive urinary Nandrolone metabolites >2ng/ml (Avois et al., 2007). The urinary concentrations reached 450 ng/mL and 70 ng/mL for 19-NA and 19-NE, respectively. The study demonstrated that concentrations >2ng/ml could be found in samples, 15 days after the last administration of the drug, depending on individual metabolism. Due to poor bioavailability of ophthalmic solutions, it was not expected to obtain such high urinary concentrations and such discrepancies between individuals. Poor bioavailability of ocular drugs has been documented in the literature (Kaur et al., 2004). Quantification indicated a great variability in terms of inter- and intra-individual excretion of Nandrolone metabolites, with respect to this medication. Ophthalmic pharmaceuticals are often considered “harmless”. Sport’s Physicians have not always been aware they can lead to a “positive” urine, even several weeks after the last administration and do not warn athletes against using this kind of medication. Can an ophthalmic delivery elevate the serum levels of Nandrolone to an extent where they increase muscle development? Further research is required to quantify if Keratyl can be used for therapeutic medical management of the ageing musculoskeletal system.