|Figure 1: External photograph of nasal displacement with soft tissue swelling, left upper and lower eyelid erythema and edema.|
Past medical, surgical and ocular history were noncontributory. The patient’s social history was notable for recent immigration to the United States from El Salvador eight weeks prior to presentation. The patient denied tobacco or illicit drug use and drank alcohol socially. He had no known drug allergies.
|Figure 2: Extraocular motility montage disclosing limited up-gaze with mild hypoglobus of the left eye. |
On examination, axillary temperature was 101.7 degrees Fahrenheit; the remaining vital signs were within normal limits. Ocular examination showed uncorrected visual acuity of 20/25 in both eyes. Pupils were equal and briskly reactive, without an afferent pupillary defect. Confrontation visual fields and Ishihara color plates were full bilaterally. External examination disclosed displacement of the nasal bridge to the right with moderate left upper and lower eyelid erythema and mild edema (Figure 1). Extraocular motility was full OD but limited OS, most notably in up-gaze (Figure 2).
Slit lamp examination of both eyes was unremarkable. Intraocular pressure by Goldmann tonometry was 14 mmHg OD and 17 mmHg OS. Hertel exophthalmometry disclosed 3 mm of relative left-sided proptosis. Dilated fundus exam in both eyes was unremarkable.
Please click this link for diagnosis, workup, treatment and discussion.