The Umbrella That Reached Too Far
neuro ophthalmology
Patient Demographics
Age: 53 years
Gender: Male
History of Presenting Complaint
Presented following a penetrating injury to the left orbit, sustained from an umbrella.
Past Medical History
- Not specified
Examination Findings
Visual Acuity
OD: recordable (sufficient for formal field testing). OS: No Perception of Light (NPL)
Pupils
Left eye consistent with a dense afferent pupillary defect, in keeping with NPL vision
Extraocular Movements
Severely restricted in multiple directions of gaze, particularly affecting the left eye (see clinical photographs) — possible additional CN VI involvement given the abduction limitation seen
Anterior Segment
Left ptosis
Posterior Segment
Neurological examination: right hemiplegia; dense aphasia. Visual field: right eye demonstrates a right upper temporal quadrant field defect
Which investigations would you choose?
Try to decide before revealing the results. You have 2 attempts.
CT brain (axial)
CT angiography (or catheter angiography)
Formal visual field testing of the right eye
Clinical photography of lids and gaze positions
Temporal artery biopsy
0 of 4 investigations selected
Investigations (Locked)
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