A 72-year-old man presents to the Emergency Department with left eye pain. Earlier this evening, he was involved in a fistfight and reports getting punched in the eye with no loss of consciousness. He now has eye pain and blurry vision. On physical exam, his visual acuity is 20/50 in the left eye and 20/20 in the right eye. His intraocular pressure is 14 on the left.

What is the most likely diagnosis?

A. Hordeolum
B. Hyphema
C. Subconjunctival hemorrhage
D. Vitreous hemorrhage

The most likely diagnosis for the man with eye pain and blurry vision after getting punched is a hyphema, consistent with his symptoms and normal intraocular pressure. Glaucoma is unlikely due to the normal pressure reading. Regular intraocular pressure testing is recommended for individuals over 40 to prevent glaucoma.

Explanation:

The most likely diagnosis for the 72-year-old man presenting with left eye pain and blurry vision following trauma to the eye is a hyphema. A hyphema is a bleeding or a pool of blood inside the front part of the eye (between the cornea and the iris) which can be caused by trauma. Given that the patient has a visual acuity of 20/50 in the left eye and an intraocular pressure of 14, which is within the normal range, a hyphema is more consistent with these findings than other options presented in the question. Conditions like hordeolum (a stye) or a subconjunctival hemorrhage would not typically cause blurry vision to the degree described, and a vitreous hemorrhage usually presents with a higher intraocular pressure.

Glaucoma would be less likely considering the intraocular pressure is not elevated. It is important for older individuals, especially those over 40 years old, to have their intraocular pressure tested routinely due to the increased risk of developing glaucoma. A normal intraocular pressure helps to maintain the shape of the eye and avoid damage to the optic nerve that can arise from conditions like glaucoma.