Occurrence: may follow impacts with low to moderate energy (small missiles, punches, sport impact)
Clinical features:
(1) vertical diplopia
(2) rounding of extraocular muscle on CT scan
(3) orbital emphysema
(4) displacement of the globe down (hypo-ophthalmos) and/or inwards (enophthalmos), as orbital contents herniate into the maxillary sinus
(5) oculocardiac reflex
(6) dilation or other abnormality of the pupil
(7) decreased sensation or numbness (hypesthesia) of Cranial Nerve V2 (infraorbital)
Medical management for orbital emphysema:
(1) The patient should avoid blowing his/her nose.
(2) Prophylactic antibiotics are indicated until the emphysema resolves.
Indications for surgical correction:
(1) evidence of entrapped muscle or orbital tissue on imaging studies
(2) significant diplopia affecting the field of gaze
(3) significant enophthalmos
(4) oculocardiac reflex
(5) large fracture of the floor (> 50% of area on imaging studies)
