Which sign is most indicative of a blow-out fracture of the orbit after blunt trauma?

Which sign is most indicative of a blow-out fracture of the orbit after blunt trauma?

• A. Enophthalmos
• B. Proptosis
• C. Ptosis
• D. Diplopia

Answer: (A)

Orbital blow-out fractures change the volume inside the eye socket, and the globe tends to sit further back in the orbit as the floor gives way and orbital contents herniate into the maxillary sinus. This posterior displacement, or enophthalmos, is the most specific sign of a blow-out fracture because it reflects a structural change in the orbit itself, not just a transient effect from swelling. Diplopia can occur when the inferior rectus is entrapped or the eye muscles are irritated, but double vision can arise from other injuries too and isn’t as definitive. Proptosis, or forward bulging of the eye, is more typical of acute swelling, hemorrhage, or other orbital processes rather than a classic floor fracture. Ptosis might occur with nerve injury but doesn’t specifically indicate a blow-out fracture. So enophthalmos stands out as the best indicator of this injury pattern, keeping in mind that it may be subtle early on and become more apparent as swelling decreases and the orbit’s altered geometry remains.

Orbital blow-out fractures change the volume inside the eye socket, and the globe tends to sit further back in the orbit as the floor gives way and orbital contents herniate into the maxillary sinus. This posterior displacement, or enophthalmos, is the most specific sign of a blow-out fracture because it reflects a structural change in the orbit itself, not just a transient effect from swelling.

Diplopia can occur when the inferior rectus is entrapped or the eye muscles are irritated, but double vision can arise from other injuries too and isn’t as definitive. Proptosis, or forward bulging of the eye, is more typical of acute swelling, hemorrhage, or other orbital processes rather than a classic floor fracture. Ptosis might occur with nerve injury but doesn’t specifically indicate a blow-out fracture.

So enophthalmos stands out as the best indicator of this injury pattern, keeping in mind that it may be subtle early on and become more apparent as swelling decreases and the orbit’s altered geometry remains.