A 22-year-old man is brought to the emergency department for the management of facial trauma sustained during an assault at a nightclub.  The patient thinks he was knocked out but isn’t sure. He denies any vomiting, change in vision, or other complaints.

Vital Signs and Physical Examination

All of the patient’s vital signs are within normal range. Physical examination results are unremarkable except for “drunk talk” and multiple facial contusions and lacerations with the most severe swelling around the left eye. The left eye is examined for proptosis, visual acuity, afferent pupillary defect, ruptured globe, and foreign body present. A computed tomography (CT) scan of the patient’s head is taken (Figure 1).

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