Blowout fractures of the orbit often cause diplopia. The most typical presentation involves fracture of the orbital floor with entrapment of the inferior rectus muscle or its fascial attachments. This entrapment, best illustrated with coronal CT of the orbit, mimics the pattern of vertical strabismus often present in TED. Less commonly, the medial rectus muscle becomes entrapped (see Chapter 2, Fig 2-14). Paretic strabismus from swelling also may occur in the acute phase. In either case, as the swelling resolves, so may the diplopia. Hence, decisions about the need for surgery for orbital blowout fractures must be made judiciously. See also BCSC Section 7, Oculofacial Plastic and Orbital Surgery.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.