A 30-year-old male is punched in the right eye during an altercation. He has subconjunctival haemorrhage, periorbital swelling, and diplopia on latera...

Question

A 30-year-old male is punched in the right eye during an altercation. He has subconjunctival haemorrhage, periorbital swelling, and diplopia on lateral gaze to the right. On examination, his right eye cannot fully abduct (look to the right). What cranial nerve is affected and what fracture pattern should be suspected?

Accepted Answer

CN VI (abducens nerve) palsy causing inability to abduct the right eye - consider a medial orbital wall blowout fracture with entrapment of the medial rectus, or raised intracranial pressure from associated head injury

Answer

CN VII (facial nerve) palsy - Bell's palsy

Answer

CN IV (trochlear nerve) palsy - superior oblique dysfunction

Answer

CN II (optic nerve) injury - optic neuritis

Answer

CN III (oculomotor nerve) palsy - posterior communicating artery aneurysm

uk-dipimc MCQ (SBA): CN VI Palsy from Orbital Fracture