SAEM Clinical Image Series: Eye Pain After Assault

carotid cavernous fistula

A 33-year-old male presents with intermittent blurry vision and left eye pain for 3 months, and a left-sided orbital headache for 1 day. He reports getting punched in the left side of the head during an altercation a few months ago. The eye pain is worse with ocular movements and is associated with bilateral conjunctival injection and white/green discharge from the left eye.

The patient was seen at another emergency department 3 months prior for the same symptoms. He was then found to have left-sided proptosis, visual acuity 20/60 in the left eye, no fluorescein uptake, and a normal fundoscopic exam. The patient was instructed to follow up with ophthalmology but did not. The patient denies fevers, chills, dizziness, nausea, vomiting, and abdominal pain.