Review Question - QID 214721

A 31-year-old man is brought to the emergency department following a motor vehicle accident. He was a restrained driver in a car driving at 60 mph that was T-boned. He reports hitting his face on the steering wheel but denies loss of consciousness. He is currently complaining of left lower abdominal pain, bilateral eye pain, and double vision that is worse with upward gaze. The patient is hemodynamically stable upon arrival, and a bedside focused assessment with sonography for trauma (FAST) does not reveal any pericardial or intraabdominal fluid. He denies any vision changes but endorses pain with eye movement. A physical examination after cleaning his face reveals significant ecchymosis of the left orbit, a limited upward gaze of the left eye, and findings shown in Figure A. What is the most likely explanation for this patient’s symptoms?