Manu Madhok, MD, MPH

A 4-year-old girl was brought to the emergency department after she sustained an injury to her jaw in a car accident. She had been restrained in the rear passenger seat with a seat belt. She had not lost consciousness and was not ejected from the vehicle.

Vital signs were normal. The patient had left-sided periorbital edema with slight ecchymosis and enophthalmos. There was conjunctival injection of the left eye, but no hyphema was noted. Pupils were equal, round, and reactive. Extraocular muscles revealed some restriction with upward gaze. Tympanic membranes were intact without hemotympanum. Nasal and oral examination findings were normal.

On waking up from a nap, a 5-month-old infant was noted to have a watery right eye. The mother thought an eyelash was the problem and flushed the eye with water. Soon afterward, the eye watered again and began to close. There was no history of injury, foreign body, upper respiratory tract symptoms, or fever.