A 36-year-old man presented 1 week after a motor vehicle accident complaining of persistent binocular diplopia. On initial exam, he experienced profound bradycardia with near loss of consciousness on attempted upgaze, restriction in supraduction, and 2 mm of enophthalmos. A virtual reality model of the orbit showed a floor fracture with inferior rectus tethering at the posterior fracture ledge. The assisting resident measured the defect to be 26 x 17 mm using the virtual reality model. The patient then underwent a transconjunctival orbital fracture repair with placement of a 32 x 20 x 1-mm poly-DL-lactic acid implant, secured with a resorbable pin. Appropriate positioning of the plate on the posterior edge of the fracture was confirmed with direct endoscopic visualization. Postoperatively, there was resolution of the patient's enophthalmos, diplopia, and motility defects. Computed tomography confirmed the appropriate location of the implant.

Financial Disclosures: Drs. Pete Setabutr, Van Tran, Sruti Akella, Sudarshan Srivatsan, and Daniel Lee disclose no financial relationships.