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This 31-year-old man was involved in an altercation three days ago. He was struck in the right temple with a screw driver. He now complains of vertical diplopia that measures 12 prism diopters right hypotropia. Ductions show a slight limitation of elevation in the right eye. The remainder of the eye examination is normal. Vision is 20/20 (6/6) in each eye. The skin in the right temple area is reddened with a small scab.

1.	The double vision is:
	d -- probably related to the trauma The history of trauma must be taken seriously and is the most important thing to be considered.
2.	The following could be the reason this man cannot look up normally with his right eye:
	e -- all of the above All of these are causes of limitation of elevation of the right eye and must at least be considered.
3.	What test would you want to do next?
	a -- CT scan of the orbits In a case of trauma like this with a question of some problem in the orbit, a CT scan is important.  In this case it shows a defect in the lateral orbit wall.  Undoubtedly the tip of the screwdriver entered the orbit and produced some swelling or hematoma and this is causing the limited elevation and the diplopia.  In a case like this, it would be best to simply observe the patient.  The swelling is likely to resolve and the diplopia and limited elevation will disappear.  The patient could be given antibiotics to cover the possibility of infection or at least should be observed carefully for this.