Visual acuity is the vital sign of the eye and should be recorded in all patients that present with visual problems. Dr Tim Root has produced an excellent video on the paediatric eye exam.

As well as acuity you need to check eye movements, and possible associated diplopia. Restriction of upward gaze suggests entrapment of either the inferior rectus or its associated fat.

Traumatic mydriasis, corneal abrasions or lens dislocations (although extremely rare in children) can also cause an acute visual disturbance following a blow to the orbit.

Albert’s eyes look normal with no peri-orbital bruising or bony crepitus though he does have ongoing pain and restriction on vertical gaze.