A 28-year-old man sustains a blunt orbital injury in a road traffic accident. CT orbit shows a large blowout fracture of the orbital floor with entrapment of the inferior rectus muscle. The patient has persistent diplopia in primary gaze with positive forced duction test, but no clinical signs of ischemia or vision loss. The recommended management is:
- A Observation with oral steroids for 6 weeks
- B Urgent surgical repair within 24 hours regardless of findings
- C Surgical repair within 1-2 weeks if diplopia persists with evidence of entrapment ✓
- D Radiotherapy to reduce orbital fibrosis
Correct answer: C. Surgical repair within 1-2 weeks if diplopia persists with evidence of entrapment
Explanation
Orbital floor blowout fracture with persistent diplopia in primary gaze, positive forced duction test, and CT evidence of inferior rectus entrapment warrants surgical repair within 1-2 weeks. Observation is reserved for fractures without entrapment or diplopia in primary gaze. Surgery is not emergent unless there is oculocardiac reflex or muscle ischemia (peak-orbit syndrome).
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.