Question

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?

Answer

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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