One-and-a-half syndrome secondary to transorbital penetrating injury.

A 46-year-old woman sustained a penetrating left eye (OS) injury after tripping and falling onto a motorcycle antenna. She removed the antenna immediately and presented to the emergency room complaining of diplopia. Examination demonstrated proptosis and subconjunctival hemorrhage OS. Her diplopia was initially attributed to mechanical restriction OS secondary to retrobulbar hemorrhage visualized on CT scan (figure 1). Careful examination, however, revealed left conjugate horizontal gaze palsy and left internuclear ophthalmoplegia. This was consistent with one-and-a-half syndrome from left pons penetrating trauma, confirmed on MRI (figure 2). Two months later, her condition had improved, but she continued to demonstrate abduction paresis OS.