A 30-year-old man sustains blunt trauma to the left orbit. He has vertical diplopia worse in upgaze, enophthalmos, and infraorbital numbness. CT confirms an orbital floor fracture with herniation of orbital fat. The finding that MOST strongly indicates the need for urgent surgical repair is:

• A Enophthalmos of 1 mm
• B Infraorbital hypoesthesia
• C Presence of subconjunctival hemorrhage
• D Restriction of elevation with positive forced duction test due to muscle entrapment ✓

Explanation

Entrapment of the inferior rectus and surrounding tissue causing restricted elevation with a positive forced duction test is an indication for early repair, particularly when accompanied by diplopia in primary gaze or a large fracture. Infraorbital numbness usually recovers spontaneously, 1 mm of enophthalmos is cosmetically insignificant, and subconjunctival hemorrhage is nonspecific. Diplopia persisting beyond about two weeks despite conservative management also favours repair.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.