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Image challenge
ABCDE2…expose the eye
  1. Eleftherios I Agorogiannis1,
  2. Arun Sachdev2
  1. 1Department of Ophthalmology, Aintree University Hospital, Liverpool, UK
  2. 2Department of Ophthalmology, Macclesfield District General Hospital, Macclesfield, Cheshire, UK
  1. Correspondence to Dr Eleftherios I Agorogiannis, Department of Ophthalmology, Aintree University Hospital, Longmoor Lane, Liverpool L9 7AL, UK; eleftherios.agorogiannis{at}gmail.com

https://doi.org/10.1136/emermed-2015-205288

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    Clinical introduction

    A 73-year-old man presented after a blunt left-sided orbital injury by a screwdriver. He had been seen at an emergency department 3 days previously but was unable to open his eye owing to tense eyelid oedema, and was discharged to follow-up with ophthalmology. He feels the swelling is improving and can now open his left eye (figure 1). Visual acuity is light perception only, he has restriction of extraocular movements and a left relative afferent pupillary defect, and the globe looks proptosed and feels hard on palpation. The right eye is normal with a Snellen visual acuity of 20/20.

    Figure 1

    Patient at presentation. Note marked periorbital ecchymosis, subconjunctival haemorrhage and the absence of a left red reflex. Patient's written consent …

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    Footnotes

    • Contributors Both authors contributed to clinical care of the patient, wrote and reviewed the manuscript and approved its final version.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.