A 10-year-old boy presents is brought in with complaints of right eye pain and double vision. The patient claims he ran into a classmate while playing football after school one week ago. He denies any loss of consciousness at the time of the accident. He denies headache, vomiting, neck or back pain.
On examination, the patient has proptosis of the right eye with periorbital ecchymosis. Visual acuity and visual field testing were normal without deficit. Fundoscopic exam was normal. Pupils were equal, round, and reactive to light, without evidence of pupillary afferent defect. Extraocular movements demonstrated limitation of upward gaze and adduction of the right eye.
1. What is your suspected diagnosis at a glance?
2. What is your next step?