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Blow-Out Fracture, Emergency Medicine

Reviewed 06/2017



  • Defined as an orbital floor fracture without orbital rim involvement

  • Results from sudden blunt trauma to the globe:

    • Typically caused by the force of a projectile > half the size of ...


Signs and Symptoms

  • Periorbital tenderness, swelling, and ecchymosis

  • Impaired ocular mobility or diplopia:

    • Restricted upward gaze owing to inferior rectus entrapment

    • Restricted ipsilateral latera...



  • Metal protective eye shield if possible globe injury

  • Place in supine position.

Initial Stabilization/Therapy

Initial approach and immediate concerns: 
  • Assess for associated intracran...



Admission Criteria

  • Rarely indicated

  • 85% resolve without surgical intervention.

  • Consultation with facial trauma service in ED and consideration for admission if:

    • 50% of floor fractured

    • ...

Pearls and Pitfalls

  • Be hypervigilant in checking pupillary response and visual acuity:

    • Abnormal results may be the 1st sign of serious complications:

      • Globe rupture

      • Optic nerve injury possibly stemming fr...

Additional Reading

  • Alinasab  B, Ryott  M, Stjärne  P. Still no reliable consensus in management of blow-out fracture. Injury.  2012;45:197–202.

  • Cruz  AA, Eichenberger  GC. Epidemiology and managem...



  • 376.52 Enophthalmos due to trauma or surgery

  • 802.6 Closed fracture of orbital floor (blow-out)

  • 802.7 Open fracture of orbital floor (blow-out)


  • H05.429 Enophthalmos due to trauma or surgery...

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