This patient sustained blunt trauma directly to his left eye. In addition to examining him for a ruptured globe, retrobulbar hematoma, hyphema, corneal injury, and more, we need to check his extraocular range of motion. He can look down without difficulty, but with upward gaze his left eye is restricted. He has no issues with looking to his right or to his left.
Not only does he develop diplopia with upward gaze, but we see that his eyes have become disconjugate. This is a sign of inferior rectus entrapment due to an inferior orbital blowout fracture.
A non-contrast CT of his face and orbits was obtained, which confirms this finding. There is a fracture with herniation of fat and the inferior rectus muscle. This is shown on the coronal and sagittal sections.
Additional examples shown include a video of a patient with a severe diplopia with upward gaze and a CT showing a right inferior orbital fracture.
Just having CT findings alone doesn’t mean there is clinical entrapment – it’s a clinical diagnosis.
These patients need consultations with a facial surgeon to help determine next steps in management and urgency of operative repair.
Peer reviewed by Mel Herbert, MD, Anand Swaminathan, MD, Whitney Johnson, MD, and Jessie Werner, MD.