An orbital blowout fracture is a break of the thin floor or inner wall of the eye socket after a direct blow, such as from a fist or ball. Orbital fat or an eye muscle can get trapped in the fracture.
Key symptoms
- Swelling and bruising around the eye
- Double vision, mostly when looking up
- Numbness of the cheek and upper lip
- Eyelid swelling that gets worse after blowing the nose
What you find on exam
- Limited upward gaze
- Sunken eye (enophthalmos)
- Numbness over the infraorbital nerve area
- Crackling under the skin from trapped air (subcutaneous emphysema)
- Check vision and look for an injury to the globe
Tests
- CT of the orbits without contrast
- Ophthalmology exam for associated eye injury
- Forced duction test by a specialist if entrapment is unclear
Treatment basics
- No nose blowing; ice packs and head elevation
- Nasal decongestant and antibiotics in selected cases
- Short course of oral steroids to reduce swelling
- Surgery for entrapment, large fractures or a sunken eye
Red flags
- Trapped muscle with nausea, vomiting or a slow heart rate (oculocardiac reflex), mostly in children
- Vision loss or a tense, bulging eye (retrobulbar hemorrhage)
- Signs of globe rupture
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.