Clinical introduction

A healthy 53-year-old man presented to the emergency department with a swollen lower eyelid, that emerged after blowing his nose. He had a one-sided scooter accident earlier that day. Initially, he had no problems, but contacted his general practitioner when the swelling emerged.

Examination of the eye showed swelling of the left lower eyelid with a small haematoma and palpable crepitus. Multiple small vesiculae were noticed on the temporal bulbar conjunctiva (figure 1). Patient had perfect vision, no eye movement restrictions and normal pupil reflexes. Further physical …