R. NICKBRYANMDS. JAMESZINREICHMD
A 40-YEAR-OLD man presented with a 2-month history of sudden-onset diplopia on upward gaze. The diplopia was worsened by fatigue, use of alcohol, and eye strain. The patient denied eye pain, visual change, nasal discharge, headache, weakness, or trauma. He had previously been seen by an ophthalmologist, who had found no abnormalities other than mildenophthalmos after thorough evaluation. The head and neck examination revealed 4 mm of enophthalmos of the left eye (Figure 1 and Figure 2). There was noted diplopia on upward gaze; however, there were no gaze palsies or visual acuity deficits. The nasal examination revealed a right septal deflection with minimal nasal obstruction. There was no purulence, necrosis, or congestion noted. A computed tomographic scan of the sinuses was subsequently performed (Figure 3 [note left and right sides are opposite those of standard computed tomographic scans] and Figure 4).
Kim SA, Mathog RH. Radiology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2002;128(1):81. doi: