A 28-year-old man sustains a blunt injury to the left eye. CT orbit shows a large orbital floor fracture with herniation of orbital fat and inferior rectus muscle into the maxillary sinus. He has persistent diplopia in upgaze and a Hess chart confirms inferior rectus entrapment. Which additional finding is a definitive indication for surgical repair?
- A Periorbital echymosis persisting beyond 1 week
- B Enophthalmos of 2 mm or more ✓
- C Subconjunctival hemorrhage resolving over 10 days
- D Epistaxis lasting 48 hours
Correct answer: B. Enophthalmos of 2 mm or more
Explanation
Surgical repair of an orbital floor fracture is indicated when there is significant enophthalosis (≥2 mm), persistent diplopia with positive forced duction test, or a large fracture involving more than 50% of the floor with entrapment. Enophthalmos of 2 mm or greater is a well-established definitive indication for repair. Periorbital echymosis, subconjunctival hemorrhage, and transient epistaxis are not surgical indications.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
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