A Bubble of Trouble
neuro ophthalmology
Patient Demographics
Age: 62 years
Gender: Male
History of Presenting Complaint
Presented with diplopia following stab wounds to the face.
Past Medical History
- No significant past medical history reported
- Not on anticoagulant or antiplatelet therapy
- Tetanus immunisation status unknown at presentation and addressed as part of the initial trauma work-up
Examination Findings
Visual Acuity
OD: 6/6. OS: 6/12
Pupils
Left RAPD present, consistent with optic nerve compromise
Extraocular Movements
Reduced abduction (left) and reduced depression (left)
Anterior Segment
Left conjunctival injection and chemosis. External: multiple sutured lacerations — nasal bridge, and left inferior periorbital region
Posterior Segment
Mild left proptosis, consistent with the volume of orbital air present
Which investigations would you choose?
Try to decide before revealing the results. You have 2 attempts.
CT orbits (axial, coronal and sagittal)
Clinical photography of the face and motility
Forced duction testing
Serial visual acuity, pupil and colour vision assessment
MRI orbits as the first-line imaging modality
0 of 4 investigations selected
Investigations (Locked)
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