ABSTRACT
A 34-year-old male was involved in an altercation during which he was hit on the forehead with a baseball bat. He was believed by his friends to have temporarily lost consciousness, and then was brought to the emergency room due to confusion and swelling over the left eye. The patient was not oriented to place on arrival to the ER, but this problem resolved shortly thereafter. A CT scan showed a small frontal bone fracture overlying the frontal sinus, as well as a small fracture in the roof of the optic canal (Figures 7.1). On examination the visual acuity is reduced to light perception in the left eye and is 20/20 in the right eye. The local ophthalmologist on call is consulted to address this finding. A 3.0 log unit relative afferent pupillary defect OS is identified. Motility exam is normal. Portable slit lamp exam is normal, and direct ophthalmoscopy reveals a normal optic nerve OU (Figures 7.2 and 7.3).
