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ddxof

A Critical Black Eye

Fadial, Tom MD

doi: 10.1097/01.EEM.0000581536.60652.94
ddxof

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A young man was punched multiple times in the face and came to the ED with double vision, worse with upward gaze. An examination revealed right periorbital edema with associated limitation to upward gaze.

Coordinated eye positioning is affected by voluntary movements (requiring cranial nerve control for conjugate eye movements), vergence (for depth adjustments), and reflexive adjustments for head movement (requiring vestibular input). As with any motor activity, neuromuscular control must be normal with unrestricted movement of the globe within the orbit.

The algorithm shown uses features of the history and physical examination to identify potential etiologic causes of diplopia.

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Suggested Readings:

  • Neurologist 2005;11(2):98.
  • Semin Neurol 2010;30(1):54.
  • Am J Case Rep 2015;16:220; http://bit.ly/2D4nDB9.
  • Continuum (Minneap Minn) 2014;20(4 Neuro-ophthalmology):942.
  • Rosen's Emergency Medicine; Concepts and Clinical Practice. 8th ed., Elsevier Health Sciences; 2013:176.
  • Eur J Emerg Med 2014;21(2):118.
  • BMJ 2015;351:h5385.
  • J Neurol Neurosurg Psychiatry 2004;75(Suppl 4):iv24.
  • Emerg Med Clin North Am 2016;34(4):967.
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Dr. Fadialis an assistant professor of emergency medicine at McGovern Medical School in Houston. As the educational technology and innovation officer there, he develops unique educational tools, including algorithms that can be found athttps://ddxof.com. His other medical education projects can be found athttp://fadial.com.

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