A 6-month-old male presents with left eye periorbital edema. His mother states that four days prior, the patient suffered an accidental “headbutt” from his older brother when the brother leaned backward and his head hit the patient around their left eye and forehead. The mother noticed immediate left eye periorbital edema and erythema. Since the injury, the patient’s left eye has progressively swollen shut and he is unable to spontaneously open the eye (see photo). She also noticed that the child cannot move the left eye when she forcibly opens his eyelids.
Your examination reveals a normal-appearing right eye with normal fixation and tracking behavior. However, the left eye has a complete ptosis and when you open the eyelid, you note poor tracking behavior, and a round, non-reactive, 4mm pupil with an rAPD. Additionally, the eye is exotropic and there is limited motility (ductions) in all directions as well as moderate proptosis and displacement of the globe inferiorly. Dilated fundus exam is notable only for possible mild pallor of the left optic disc. A CT scan of the head was performed at an outside hospital and was read as “Normal CT of the head”.
Case contributed by: Lucas W. Rowe, MD. Indiana University School of Medicine