A patient presents with sudden onset eye pain.  He states he was watching his friend’s car get towed out of a snow drift that had suddenly appeared beneath it, when the towing cable snapped and the pain began.   He shows you this picture from his camera, taken right before symptom onset.

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What is the best test to determine the etiology of the pain?

A. MRI

B.Ocular Pressure

C.Seidel’s test

D.Ocular Ultrasound

Answer : C.  The patient possibly has a foreign body in his eye from the cable snapping and sending metal shards flying, which would result in a positive Seidel Test.  While an MRI would be both diagnostic and “therapeutic” it is not recommended.  Ocular US is not recommended if the possibility of globe rupture is present.

Bonus : If the pain had begun 6 hours after the picture had been taken, what condition would have been most likely?

Answer :  Photokeratitis from sunlight being focused by the bright yellow car.