Case Two

a You are asked to perform pupil examination on this patient (no prosthesis in this case). From observation alone are you able  to tell what you are likely to find? What further examination would  you like to perform? Answer The most striking feature in this patient is facial asymmetry  with the left globe lying in a lower and more lateral position. This suggests that the patient may have previous severe orbital injury. As the pupils in both eyes are of the same size, the most  likely finding will be a left relative afferent pupillary defect. Further examination will be fundoscopy looking for optic atrophy. This patient had right traumatic optic atrophy resulting from orbital fracture in a road traffic accident.   a Return to observation II