(d) Diplopia (double vision)
Enophthalmos (displaced eyeball receding in orbit).
(f) Limited eyeball motion upward inward, upward outward, and
downward gaze on the injured side.
(3) Diagnosis. Diagnosis is made by taking a patient history. Did the
patient experience a direct blow to the soft tissues of the orbit? Conduct a physical
examination of the movement of the eyes. The coordinated action of six muscles
controls the movement of each eye. Asking the patient to move his eyes in a specific
direction can not only test the function of the six muscles but also help determine the
presence of a blowout fracture. In order to test the eye movement of the patient, ask
him to follow your finger or a pencil as you move through the six cardinal fields
(directions) of gaze. Moving your finger or a pencil at a comfortable distance from the
patient, ask him to look to the right; upward to the right of the midline; straight down; to
the left; upward to the left of the midline; straight down.
(4) Treatment. Protect the area from further injury. Evacuate the patient for
b. Tripod Fracture.
(1) Description. A tripod fracture is caused by a blow to the cheekbone.
The fracture occurs at the juncture of three bones in the cheek.
(2) Diagnosis. Diagnosis is made by taking a patient's history. Did the
patient suffer a blow to the cheekbone? A physical examination should reveal a
lessened sensitivity to touch in the affected area.
(3) Treatment. Protect the area from further injury. Evacuate the patient for
c. Mandibular Fracture.
(1) Description. The mandible is the lower jaw. Mandibular fractures are
very common and usually not life-threatening. The mandible bone is very strong, but
there are areas of relative weakness where fractures can occur. Mandibular fractures
occur more often in areas without teeth than areas with teeth. The patient may only
complain of one area of tenderness. Since the force of any blow to the mandible is very
strong, look for fractures in other facial areas.