A patient was a 20-year-old female who was involved in a physical altercation that resulted in...

A patient was a 20-year-old female who was involved in a physical altercation that resulted in a closed fist blow to the right side of his face. He immediately noted double vision. Later, he experienced significant pain when attempting to look up and associated nausea and vomiting. BCVA: Right eye (OD): 20/40, Left eye (OS): 20/20 a) Write the associated clinical signs for the above case. b) What are the clinical tests do you performed and why? c) Write the differential diagnosis and most appropriate diagnosis with management.

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Expert Solution

20 yrs old female,c/c_pain when attempting to look up associated with nausea and vomiting,History of closed fist blow to rt side of face with diplopia.BCVA showing lt eye nomal and rt eye VA 20/40(mild).

Associated clinical signs are 1.primery deviation _it us the deviation from affected eye and from the action of affected muscle.2_secondary deviatIon

3.Limitation of occular movement_occours in the direction of affected muscle

4.compansatory head posture_adopted to avoid diplopia and confusion,occular torticollis.

5.false projection of orientation can be there.

6.there is no amblyopia .

Clinical tests we need to perform_

1.signs of any other physical injury or black eye

2. Evaluation of strabismus_diplopia charting,hess screen test,field of binocular fixation,forced duction test,

3. Any signs of infection or inflammation present then accordingly investigations done .

4. Slitlamp examination, ddo, indirect ophtalmoscopy ,retinoscopy, iop measurement are to be done.

5. Cranial nerve testing especially 3 rd ie occulomotor (superior rectus and inferior oblique responsible for upward gaze)

6. Orbital imaging can be done like waters view xray, CT scan, MRI,

7. Ear abnormalities must be ruled out.

Differential diagnosis are _1. Paralytic squint

2. Nonparalytic squint,

3.fractures,

4.any scleral,coneal injury

5.subluxation of lens

Most probable cause here may be paralytic quint due to superior rectus and inferior oblique paralysis (traumatic lesion inform of laceration ,disinsertion, haemorrhage into the muscle substance or seath in blow out fractures of orbital walls_floor or medial wall) .

Management_first attempt must be made to find the cause of such presentation and if possible treat it.

Treatment of annoying diplopia _use of occluder on affected eye, with intermuttent use of both eyes with changed head posture to avoid supression of amblyopia.

Surgical treatment can be done.

Sydney Mullin answered 11 months ago

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