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EM@3AM: Retrobulbar Hematoma

A 35-year-old male presents with left eye pain and vision loss after an unwitnessed altercation. On exam, there is significant left periorbital edema and ecchymosis; the left eye appears mildly proptotic. He is unable to open the eye unassisted due to swelling and pain. His left eye has conjunctival injection, chemosis, and a dilated pupil, which is non-reactive to direct light but constricts in response to light shone in the contralateral eye. The patient is unable to participate in extraocular testing secondary to pain and distress. Intraocular pressures are 18 on the right, 42 on the left.

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