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Differential Diagnosis

  • Orbital floor fracture
  • Soft tissue edema secondary to trauma
  • Traumatic diplopia
Direct Blow to the Eye x-ray 3 - the resolution
Direct Blow to the Eye x-ray 4 - the resolution

Diagnosis

This patient had a right orbital floor fracture. Findings include partial opacification of the right maxillary sinus, an irregularity on the inferior orbital rim and a subtle discontinuity on the orbital floor. The most common mechanism is a direct blow to the central orbit from a fist or ball. 

Findings/What to Look for

  • Orbital fractures can involve any wall of the orbit (medial, lateral, superior or inferior), the orbital rim, or both
  • The inferior wall is the most common fractured
  • Clinical findings can include:
    • Enophthalmos (sunken eyes)
    • Diplopia (double vision due to extraocular muscle entrapment)
    • Orbital emphysema, especially when the fracture is into an adjacent sinus
    • Malar region numbness (due to injury to the infraorbital nerve)
    • Hypoglobus (affected eye is lower than unaffected eye)

Pearls for Urgent Care Management

  • Cold packs should be applied to reduce swelling
  • Referral for ophthalmologic or surgical evaluation is needed
  • Surgery may be indicated if there is nerve incarceration, acute enophthalmos or hypoglobus, and limitation of gaze

Acknowledgement: Images and case provided by Experity Teleradiology (www.experityhealth.com/teleradiology).

A 40-Year-Old with Swelling After a Direct Blow to the Eye