MEDICAL HISTORY: Within thirty-six hours of the time of the accident, the patient arrived at the emergency department of University Hospital of the University of Medicine and Dentistry, New Jersey. He could not recall when he first experienced vision loss because his eye had swelled shut immediately after he sustained an injury. His eye remained shut at the time of evaluation. The patient reported no history of photopsias, floaters, loss of consciousness, dizziness, nausea, vomiting, recent fevers, shortness of breath, and weakness. He reported a history of frequent ethanol consumption.

The patient had hypertension, left untreated due to noncompliance, a 2-week history of occasional greenish-yellow discharge from the nose without associated fever, with several years of alcohol abuse. The patient was also involved in a motor vehicle accident resulting in “facial fractures many years ago.” The patient was not taking medication and did not recall being allergic to any medication.

VITAL SIGNS: The patient was found to have stable vital signs.

• Blood pressure: 136/90 mm Hg
• Pulse: 96/min
• Respiration: 18 breaths/min
• Temperature: 97.6° F.