BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39038.654213.47 (Published 23 November 2006) Cite this as: BMJ 2006;333:1130
  1. Iain Varley (iainvarley{at}doctors.org.uk),
  2. Craig Wales, specialist registrar,
  3. Lachlan Carter, specialist registrar
  1. 1department of oral and maxillofacial surgery, York Hospital, York YO31 8HE

    A 41 year old man presented after an alleged assault with left sided periorbital ecchymosis and tenderness. Initial occipitomental x rays were unremarkable, but at clinical review he reported diplopia and pain when looking upwards. Computed tomography showed a large fracture of the orbital floor trapping the inferior rectus muscle. This was treated by open reduction and repair of the defect with bone graft. Orbital floor fractures may not be apparent on initial x rays, and a low threshold for further imaging may be necessary when patients have suggestive symptoms.

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