Patient presents with pain, diplopia, and proptosis

A 54-year-old male presented to the Bascom Palmer Emergency Room complaining of pain, double vision, and increasing proptosis of his right eye over the past 4 to 6 weeks. He also complained of periorbital redness and temple swelling. He denied any change in vision, nausea, vomiting, fevers, chills, or photophobia.

His medical history was significant for hypertension, gout, and dyslipidemia. His social history was significant for a 25-pack-year history of tobacco use and social alcohol use. He was married with two children and was allergic to aspirin. Review of systems was unremarkable except for occasional joint and muscle pains.

Examination

Anterior segment exam of the right eye was significant for temporal conjunctival injection and chemosis. Dilated fundus examination of the right eye was significant for slight blurring of the nasal optic disc margin. There was no optic nerve pallor, hemorrhage, choroidal folds, or retinal striae. Funduscopic examination of the left eye was unremarkable.

Differential diagnosis

Case continued