A Man With Double Vision After a Fight

C. Robert Bernardino, MD


October 31, 2012

In This Article

Diagnostic Workup

The forced duction test can be helpful in determining the underlying pathology. By rotating the globe (under topical anesthesia) in the direction of motility limitation, it can be determined whether soft tissue is entrapped in a fracture, which would necessitate more urgent surgical intervention.

However, imaging of the orbit is key. In the setting of trauma, CT with axial and coronal views is essential to determine the presence of a fracture and whether entrapment of soft tissue is present.

CT revealed a large orbital floor fracture (Figure 2). The inferior rectus and associated soft tissue appeared to be displaced into the fracture but not entrapped.

Figure 2. A coronal CT (bone window) demonstrates an orbital floor fracture of the left orbit with displacement of soft tissue and the inferior rectus into the fracture.

Diagnostic Question

On the basis of the study, what is your working diagnosis now?

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