A 30-year-old male patient presents to an urgent care centre following a blow to the right side of the head near the zygomatic arch. At 30 minutes postinjury, he complains of severe pain around his right orbit as well as decreased vision in the right eye. On examination, the right eye appears proptotic. There is visible bruising around the upper eyelid and extensive subconjunctival hemorrhage. Visual acuity is 6/60 in the right eye and 6/6 in the left eye, while intra-ocular pressures are 40 mm Hg and 15 mm Hg, respectively. Ocular motility is severely impaired in all directions and pupil examination reveals only a minimal red reflex—direct response is lost. There are no obvious abnormalities detected with ophthalmoscopy.
The most likely diagnosis is
-
Retrobulbar hemorrhage
-
Acute angle-closure glaucoma
-
Orbital cellulitis
-
Subarachnoid hemorrhage
Answer on page 607
- Copyright© the College of Family Physicians of Canada