Boy notices left eye sinking over 1 month

A 12-year-old boy presented to our hospital complaining of his left eye “moving gradually downward.”He was accompanied by his aunt, his primary caretaker, who reported that approximately 1 month prior he had complained of left eye achiness and pain that had since resolved. Since that time, his aunt had noticed that his eye had gradually been moving outward and downward. He noticed no change in vision and had no pain. He had no significant medical history and was on no medications. There was no history of orbital trauma. His aunt reported he had been slightly more tired than usual over the past month, but he otherwise felt well and there was no history of fever, chills or weight loss. There was no history of diplopia and no history of upper respiratory infection or nasal congestion. He had been seen on the day of presentation at an outside hospital and transferred to our hospital urgently for further management.