You are correct. Orbital hemorrhage displaces the globe (proptosis) and causes a progressive increase in intraorbital pressure, producing a tense orbit. Compromised optic nerve fxn causes reduced vision and an ipsilateral afferent pupillary defect; damage to the nerves controlling extraocular muscles leads to ophthalmoplegia. Early recognition is essential; prompt examination for signs of proptosis and assessment of visual acuity, extraocular movements, and pupillary reflexes, easily performed by non-ophthalmologist physicians, offer sufficient information to justify lateral canthotomy/cantholysis in order to preserve sight. Owing to his late presentation, the pt was managed conservatively w/ oral prednisolone for symptomatic relief. Eight wks later, left visual acuity was no light perception, and fundoscopy showed optic nerve atrophy.

Emerg Med J 2016;33:740