Author: Hannah Thomsett / Editor: Yasmin Sultan / Codes: / Published: 27/05/2026
A 34-year-old patient presents to the Emergency Department (ED) with a 2-day history of severe, progressively worsening headache, associated with fever, nausea and general malaise. Over the preceding 24 hours, they have developed increasing swelling and redness around the right eye, accompanied by significant pain that is worse on eye movement. The patient reports new-onset double vision and describes difficulty moving the right eye.
On arrival, the patient appears acutely unwell and febrile, with tachycardia and hypotension. Examination of the right eye reveals marked periorbital oedema, chemosis and mild proptosis. Extra-ocular movements are painful and restricted in multiple directions. There is associated ptosis, and diplopia is present in primary gaze. Visual acuity is reduced compared with the left eye.
Cranial nerve examination shows impaired abduction of the right eye and reduced corneal sensation on the same side. Facial sensation is otherwise intact with no asymmetry; the left eye is unaffected.
Further history reveals a recent episode of nasal congestion and facial pain, with purulent nasal discharge several days prior to presentation, which resolved with no medical input. There is no history of trauma, recent surgery, clotting disorders, or significant past medical history.
Neurological examination shows no limb weakness or sensory deficits, although the patient appears increasingly fatigued and uncomfortable.
