Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
!
A quiet-looking eye may contain trapped muscle
A child with restricted eye movement, nausea, vomiting or bradycardia after orbital trauma may have a trapdoor fracture despite little bruising.
Action: Obtain urgent maxillofacial and ophthalmology assessment for possible entrapment, keep the child under observation and prepare for urgent intervention; separately treat rapidly declining vision with tense proptosis as possible orbital compartment syndrome.
Synopsis
Recognise orbital wall injury and extraocular tissue entrapment, prioritise sight-threatening complications, and coordinate imaging, specialist review and practical recovery advice.
A blowout fracture usually affects a thin orbital wall and may allow orbital fat or muscle to herniate into an adjacent sinus.
Check visual acuity, pupils and eye movements before concentrating on the fracture; associated globe, retinal or optic nerve injury may be more urgent.
Diplopia on upgaze, reduced elevation and cheek or upper-lip numbness support an orbital floor injury.
Key red flags
Restricted eye movement with vomiting or a slow pulse after an orbital impact, particularly in a child, requires urgent specialist assessment for entrapment and an oculocardiac reflex.
Investigation priorities
01
Visual acuity, pupils and globe inspectionFirst step
Identify sight-threatening injuries before focusing on fracture anatomy.
Management branches
Emergency screenFind the complication that cannot wait
A patient presents after a blunt impact to the orbital or midfacial region.
Assess general trauma needs and record vision, pupils and movements, looking specifically for globe rupture or orbital compartment syndrome.
Request immediate ophthalmology and maxillofacial help for a visual deficit, significant restriction or an oculocardiac response, especially in a child.
Uncomplicated recoveryReassess function as swelling settles
Specialist assessment identifies a stable fracture without an acute visual threat or urgent tissue entrapment.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.