A 20-year-old man presented to the Tufts Medical Center emergency department with left eye pain, lightheadedness, nausea and vomiting after blunt trauma to the left lateral periorbital region.
The patient was not wearing a boxing helmet while sparring with a friend and was struck in the head. He denied loss of consciousness. He complained of left eye pain exacerbated with right gaze along with difficulty moving his left eye laterally. He also noted new horizontal double vision exacerbated with horizontal eye movement and left or right head tilt. His medical, surgical and family histories were