Answer
Orbits should be examined for bony deformity, foreign body, and globe displacement.
Orbital rim fractures may be palpable and raise suspicion for entrapment and possible associated globe rupture.
Orbital crepitus indicates subcutaneous emphysema from an associated sinus fracture.
Orbital foreign bodies that may have impaled or perforated the globe should be left undisturbed until surgery.
A ruptured globe may present with enophthalmos (recession of the globe within the orbit).
An associated retrobulbar hemorrhage may cause exophthalmos, even with an occult scleral rupture.
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Media Gallery
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Operating microscope view of a globe rupture secondary to blunt trauma by a fist. Notice the dark arc in the bottom of the photo representing the ciliary body visible through the scleral breach. Subconjunctival hemorrhage of this severity should raise suspicion of occult globe rupture. Photo courtesy of Brian C Mulrooney, MD.
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