A fracture of the medial wall of the orbit is usually mixed with other facial fractures.


Occurrence: may follow impacts with moderate to high energy


Clinical features:

(1) horizontal diplopia, which may be mixed with vertical and/or oblique diplopia

(2) orbital emphysema, associated with fracture of the wall into an adjacent sinus

(3) orbital hemorrhage, which may be considerable if the anterior and/or posterior orbital artery(ies) are injured

(4) enophthalmos (retrogression of the globe, due to prolapse of peri-global tissue)


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) restrictive diplopia affecting a functional field of gaze

(2) CT scan shows entrapment of muscle or orbital tissue

(3) enophthalmos > 2 mm


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