Case history
Case history #1
A young man playing football received an elbow blow to the eye. He has double vision, and the eye looks sunken. On exam, he has periorbital ecchymosis and mild subconjunctival hemorrhage with a posterior limit. The affected eye is enophthalmic and hypoglobic. He has diplopia on upward gaze. Hess charting confirmed depression of upgaze movement with compensatory movement contralaterally.
Case history #2
A child has fallen at play on to the corner of a table and has bruising around the eye. Since the event the child has been nauseated, may have vomited, and appears ill. On exam, the affected eye does not show any subconjunctival hemorrhage. The child is bradycardic and hypotensive. There is limitation of upgaze movement of the affected eye on upgaze, a maneuver that the child was resistant to perform.
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