Three patients with orbital trauma are discussed according to differential diagnosis. Injury with a pointed object calls for auscultation of the head. Orbital hematoma can compress the space between the globe and orbital rim, making finger insertion in this space difficult; several weeks after injury a bluish-green discoloration may be seen on the sclera. Exophthalmos or enophthalmos may be associated with an early blow-out fracture. The forced-duction test may be more manifest in a small vs a large blow-out fracture. An old blow-out fracture with diplopia warrants surgical intervention to restore binocular vision.
Smith B, Wiggs EO. Differential Diagnosis in Orbital InjuryInternal Carotid-Cavernous Sinus Fistula, Orbital, Hematoma, Blow-Out Fracture. Arch Ophthalmol. 1973;89(6):484-485. doi:10.1001/archopht.1973.01000040486007