Rosh Emergency Medicine Practice Test

What is the most suggestive clinical feature of a diagnosis when considering a patient with pain and swelling in the eye?

1. Eye tenderness

2. Eyelid swelling and erythema

3. Fever and leukocytosis

4. Pain with eye movement

The correct answer is: Pain with eye movement

In the context of a patient presenting with pain and swelling in the eye, the presence of pain with eye movement is particularly suggestive of specific ocular conditions such as orbital cellulitis or other forms of inflammation. This symptom often indicates involvement of the extraocular muscles or surrounding structures, which can result from infections, inflammation, or even orbital mass effects. When a patient experiences pain during eye movement, it raises concern for conditions that could affect the orbit or the muscles responsible for eye movements. This pain suggests a more serious underlying condition compared to general eye tenderness or eyelid swelling, which might present with less specific or less acute processes. While eyelid swelling and erythema could indicate an allergic reaction or superficial infection, they do not specifically suggest deep orbital involvement, which is often accompanied by the symptom of pain with eye movement. Fever and leukocytosis are indicators of systemic infection or inflammation and while they can accompany serious ocular conditions, they are not unique to eye disease. They point to the body's systemic response rather than a localized process within the eye itself. Therefore, pain with eye movement is the most direct and potentially critical symptom when assessing for serious ocular issues.