A 23-year-old male presents to the emergency department after being assaulted 30 minutes previously. While under the influence of alcohol, he was in an altercation with another male on the street and suffered a blow to the left eye. He reports pain in around the left eye, as well as slightly decreased vision. There are no symptoms of diplopia, flashes, floaters, or visual field loss.
On exam, there is bruising of the left eyelid but no other apparent signs of trauma. Visual acuity is 20/20 and 20/50 corrected in the right and left eyes, respectively. Extraocular movements and confrontational visual fields are normal. Intraocular pressures are R 12 and L 16. Pupils are symmetric and both reactive to light, although the left appears more sluggish. There is no RAPD. Anterior segment exam is shown in the figure below of the left eye. The anterior chamber is deep with 2+ RBCs, 1+ WBC, 1+ pigment, 3+ flare, and wisps of fibrin near the pupillary margin. The lens and retina appear normal.