Patient Case: Eye injury after a fall

red eye after fall

This case of a patient presenting with a red eye after a fall was presented by a SERMO ophthalmologist.  Can you guess the diagnosis?

44 year old African American female who fell while cooking in her kitchen and hit a “statue” on her way down.  Taken to the ED where right periocular swelling and bruising with a small nasal skin scrape was noted without skin laceration.  Orbit CT showed “air in orbit, no fracture”.  Advised to use cold compresses, take tylenol, and see her PCP for glucose control since sugar in ED was 500.

Patient seen by my practice 4 days later with complaint of HA, periocular pain and photophobia.  Examination positive for acuity 20/100; lid edema and ptosis; hemorrhagic chemosis (bloody swelling of conjunctiva); moderate iritis.  Examination negative for retinal pathology.  Treatment started with topical steroid for diagnosis of traumatic iritis.

Patient seen again 7 days later with continuation of all symptoms.  Examination positive for acuity 20/300; persistence of chemosis and conjunctival injection; persistence of traumatic iritis.  Newly noted was limitation of adduction OD.

Differential Diagnosis?  Now what?

 

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