Which finding is most consistent with a blowout fracture after blunt facial trauma?

• A. Severe headache and decreased ability to move the eye
• B. Foreign body sensation in the eye
• C. Bright red blood in the conjunctiva
• D. Diplopia with eye pain

Answer: (A)

Blowout fractures compress or trap the muscles that move the eye, most often the inferior rectus, after a blunt impact to the eye socket. This entrapment leads to pain with eye movement and a noticeable limitation in how the eye can be moved, especially in certain directions like looking up, which is a hallmark of orbital floor fractures. The combination of a severe headache from the trauma and a decreased ability to move the eye directly signals this orbital involvement and muscle entrapment.

Other findings can occur with eye injuries or surface trauma, but they’re less specific for a blowout fracture. For example, a foreign body sensation points to corneal or conjunctival injury, a bright red subconjunctival blood spot indicates superficial bleeding, and diplopia with eye pain can occur in various eye conditions. However, the clear sign that aligns with an orbital floor fracture is restricted extraocular movement due to entrapment, often accompanied by pain.