Blow-out fracture
Left blow out fracture. The scar in the upper lid provides clue to 
left ocular trauma.

Left blow-out fracture causing up-gaze and 
down-gaze problems.

The affected side has enophthalmos (this may be mild). There is restriction of upgaze of the affected eye. 

In the examination:

  • look for any abnormal head posture such as chin elevation
  • mention that you like to palpate the inferior orbital rim for any step or gap due to fracture

  • (this may not be present)
  • test the sensation over the infra-orbtial region for any infra-orbital nerve entrapment.


1. The following is an X-ray of a patient who sustained an orbital injury and had problem with upgaze. Which side is the abnormality located?
2. A patient with blow out fracture may not experience problem with binocular vision except on upgaze. Can you think of any profession in which he may experience problem and what treatment may be available?

3. How do you manage a blow-out fracture?


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