Author: Ankit Sinha / Editor: Yasmin Sultan / Codes: EnC6, MaP4, NeuC10, NeuP7, OptC2, OptP2, OptP3, RP4, SLO1, SLO2, SLO4Published: 01/02/2023

A 56-year-old woman presents to the Emergency Department (ED) complaining of acute, 10/10 eye pain. She reports it has been present since she was poked in her left eye by her grandson 3 days ago. She is particularly concerned because the pain has not yet resolved, changed from a burning to a constant throbbing pain worse with light, and she notes blurry vision in her left eye. She does not wear glasses normally. The patient denies any other symptoms.

She has a history of ulcerative colitis, hypothyroidism, asthma, and anxiety, and has used recreational cocaine and benzodiazepines in the past. Her regular medications include salbutamol inhaler, citalopram, levothyroxine, and mesalazine. She denies any allergies.

On examination, she is alert and fidgeting. You find an erythematous left periorbital region with tenderness on palpation of this region (particularly nasally), loss of sensation over her left cheek, a healing laceration near the infero-medial border of her left lower eyelid, conjunctival injection, and subconjunctival haemorrhage. Right eye appears normal. No foreign bodies were observed.

Her pupils are equal and reactive to light.

Visual fields are intact and eyes have full range of movement.

Acuity is 6/9 in left eye, 6/6 in right eye

Observations: RR 16, SpO2 97% RA, HR 88, BP 154/92, T 36.5

She is agitated and anxious to go. Further assessment is interrupted by her receiving calls from her partner and being intermittently agitated.

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