Clinical Review Lesson of the week

Blunt orbital trauma

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7263.750 (Published 23 September 2000) Cite this as: BMJ 2000;321:750
  1. S B Holmes, specialist registrar (simonbholmes@hotmail.com)a,
  2. J L B Carter, consultant surgeona,
  3. A Metefa, specialist registrarb
  1. a Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB
  2. b Department of Radiology, Royal London Hospital
  1. Correspondence to: S B Holmes
  • Accepted 25 April 2000

All blunt orbital trauma, regardless of severity, should be thoroughly investigated

Orbital trauma is common and patients present to a variety of healthcare professionals depending on the type of injury. Clinical examination may reveal gross problems such as diplopia and enophthalmos, which may require radiological confirmation.

Most orbital injuries are minor and are managed conservatively. The consequences of an overlooked injury can have profound consequences, with persistent enophthalmos, diplopia, and orbital sepsis representing major morbidity when diagnosis and treatment are delayed.1 The incidence of isolated blow out fractures of the orbit is unknown. We identified 10 patients with such fractures from 170 patients with bony orbital injuries referred to our department over 20 months. We describe one of those patients.

Case report

A 13 year old boy was playing football with his friend when the ball was kicked into a neighbour's garden. They argued about who was to retrieve the ball, and the friend playfully punched the boy on the left orbit. Despite initial discomfort, he carried on playing.

Overnight the boy had minimal periorbital swelling, and the following morning he attended school as usual. He had been selected for the school basketball team but while …

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