Following blunt trauma to the face, a 21-year-old male has a severe headache and decreased ability to move his eyes. This presentation is MOST consistent with which injury?

• A. Blowout fracture
• B. Lacerated globe
• C. Ruptured eyeball
• D. Optic vessel compression

Answer: (A)

Orbital blowout fractures happen when a blunt impact to the face fractures the thin orbital floor. The floor breaks and orbital contents can push into the maxillary sinus, and the inferior rectus muscle can become entrapped. This entrapment restricts the eye’s movement, especially when trying to look upward, and often causes a severe headache or pain around the eye. The key clue here is decreased ability to move the eyes after blunt trauma, which points to muscle entrapment from an orbital floor fracture rather than direct injury to the globe itself. A lacerated or ruptured eyeball would show obvious globe damage and usually vision loss or severe ocular signs, and optic vessel compression would more likely present with decreased vision from optic nerve or retinal ischemia rather than isolated limited eye movements. So this presentation most strongly fits an orbital blowout fracture with extraocular muscle entrapment.