The Daily PANCE and PANRE Question 49

A 35-year-old male complains of acute left eye pain immediately after he struck a nail with a hammer. On examination, you note that the left pupil is elliptical. What diagnostic test/procedure will most likely confirm your diagnostic suspicion?

  1. fluorescein staining of the eye
  2. pressing on the globe to assess intraocular pressure
  3. an X-ray of the orbits
  4. testing the extraocular eye muscles
  5. having the patient finger count

Answer: C

X-ray of the orbits

This patient struck a nail (think metal splinter), the pain was immediate (as the splinter entered his eye). His pupil is elliptical, indicating penetration of the globe. He needs X-ray of the globe to look for the metal splinter. Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetrated

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