A 44 yo female presents c/o left eye pain.  Punched prior to arrival. Initially had very blurry vision, now vision obscured.  A CT is shown.  What's the diagnosis?  Scroll down for answer.

Answer:  Left ocular globe rupture

Etiology

• penetrating or blunt trauma
• patients at higher risk with history of eye surgery (Lasik, cataract, etc.)

Exam

• decreased visual acuity in affected eye (visual acuity is the vital sign of the eye!)
• peaked pupil
• bloody chemosis
• large subconjunctival hemorrhage

Diagnosis

• Seidel's sign - classic finding, fluorescein in affected eye lights up the aqueous humor and it will run / leak 
• CT scan can rule in globe rupture but not rule it out

Management

• do not check eye pressure in any suspected globe rupture - however with low suspicion and normal intraocular pressure rules out globe rupture
• rigid eye shield (not a patch) to avoid any pressure / further trauma to eye
• elevate head of bed, pain control, tetanus immunization, antibiotics, antiemetics
• ophthalmology consult in ED 

Reference

Walker RA, Adhikari S. "Eye Emergencies." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, pg 1568-69