UMEM Educational Pearls


8 year-old female presents with nausea, vomiting, double-vision and inability to move her left eye upwards after being kicked in the face at school. What's the diagnosis?


Orbital floor fracture with entrapment of the inferior rectus muscle.

  • Orbital floor fractures are the most commonly fractured part of the pediatric orbit. Although treated conservatively in adults, pediatric patients can benefit from early repair.
  • Children are at increased risk for a “trap-door” type fracture, which can entrap the extra-ocular muscles because their orbital floor is more flexible.
  • Signs of entrapment include abnormal extra-ocular movements, diplopia, nausea, and vomiting requiring urgent subspecialty evaluation.
  • Bradycardia may occur secondary to the oculo-cardiac reflex when muscle entrapment occurs and is a helpful clue when present



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