A young woman presented to the emergency department several hours after being assaulted. She had been struck in the face with a fist and lost consciousness for several seconds. On arrival, she complained of diplopia and severe pain of her left eye but denied blurred vision or changes in perception of color.
Physical examination revealed chemosis of the left eye, without enophthalmos or proptosis. The extraocular movements were minimally restricted in both superior and inferior planes, and the patient noted diplopia with these vertical eye movements. The patient reported considerable eye pain at rest that was not notably altered by extraocular movements. Palpation of the eye evoked severe pain, which she described as deep and throbbing in quality. Findings from formal visual acuity testing, fundoscopic examination, and ocular pressure testing, performed by the ophthalmology service, were normal. Computed tomographic (CT) imaging of the orbits was performed (Figure).
Fontenot TE, Carter JM, Friedlander P. Eye Pain After Traumatic Orbital Fracture. JAMA Otolaryngol Head Neck Surg. 2014;140(9):877-878. doi:10.1001/jamaoto.2014.1399