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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.
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.