Trauma - Case 3

A healthy 22 year old male comes to the emergency room complaining of vertical diplopia, which is worse when looking up, after a bar fight where he was struck with a fist in the left eye (OS).

Examination revealed visual acuity 20/20 OU, visual fields normal to confrontation, pupils equal in size and reactivity.  Extraocular movements were restricted on the left, especially on upward gaze (see below).  Palpation of the orbital rim was not painful.  Funduscopy appeared normal OU.

Case 3

What is your tentative diagnosis?

(a) Blowout fracture
(b) Orbital rim fracture
(c) Third cranial nerve palsy
(d) Both b & c
(e) None of the above