The man, in his 30s, has seen 2 specialists, received 2 diagnoses, and is now in the ED for persistent pain that is worsened by eye motion. Can you dx?
History of present illness
A man in his 30s presents to the emergency department with 2 days of ongoing left ocular pain with associated headache. He was seen 2 days ago earlier by a local ophthalmologist and was diagnosed with dry eyes. Yesterday he was seen by your EM colleague and diagnosed with a migraine. He denies any visual disturbance, blurry vision, or double vision, but his pain is worse with eye motion.
Vital signs & physical examination
Vital signs are normal. Physical exam is otherwise normal except for images shown below. Intraocular pressure is 12 mm Hg in each eye (normal <21 mm Hg).