A 28-year-old man is struck on the left eye by a cricket ball. He presents with periorbital swelling and vertical diplopia worse on looking up. There is reduced sensation over the left cheek and infraorbital region. CT shows a fracture of the orbital floor with herniation of orbital fat into the maxillary sinus.

• A Retrobulbar haemorrhage
• B Superior orbital fissure syndrome
• C Blow-out fracture of the orbital floor with inferior rectus entrapment ✓
• D Zygomaticomaxillary complex fracture without orbital involvement

Explanation

Floor fractures from blunt trauma cause herniation of orbital contents into the maxillary antrum, producing restricted upgaze with vertical diplopia and infraorbital nerve hypoesthesia over the cheek. Superior orbital fissure syndrome causes ophthalmoplegia with V1 sensory loss but follows a different mechanism and spares vision initially. Retrobulbar haemorrhage presents with tense proptosis and visual loss, not a facial fracture pattern.

Reference: Parsons' Diseases of the Eye, 23rd ed.

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Written and medically reviewed by the StethoPrep medical team.