Orbital trauma

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Eye anatomy.
  • Must assess:
    • Visual acuity
    • Anterior chamber
    • Integrity of globe
    • Pupil shape and reactivity
  • Use paperclip or eyelid speculum to open swollen eyes

Clinical Features

  • Anterior chamber is flat +/- abnormal pupil
    • Ruptured globe is certain
    • Stop the exam; place eye shield, consult ophtho
  • Hyphema
    • Evidence of significant trauma; consult ophtho
  • Extra-ocular movements
    • Restricted upgaze or lateral gaze suggests orbital fracture with entrapment
      • Obtain CT face
  • Orbital Rim
    • Feel for step-off
  • Sensation
    • Test along distribution of inf orbital nerve (below eye and ipsilateral side of nose)
  • Photophobia
    • If photophobia in affected and unaffected eye, suspect traumatic iritis
  • Decreased visual acuity +/- proptosis


Teardrop pupil.jpg
    • Bird's eye view for exophthalmos with retrobulbar hematoma
    • Worm's view for endophthalmos (blow-out fracture) or malar prominence flattening (zygoma fracture)
  • Acuity
  • Diplopia
    • Binocular diplopia suggests entrapment of extraocular muscles
    • Monocular diplopia suggests lens dislocation
  • Extraocular motion
  • Pupil
  • Pressure (only if rule out globe rupture)
    • Check in patients with exophthalmos, afferent nerve defect or evidence of [[retrobulbar hematoma]

Differential Diagnosis

Orbital trauma



Maxillofacial Trauma

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses



  • Based on specific injury


  • Depends on specific injury

External Links

See Also