direct impact on the orbit may elevate orbital pressure sufficiently as to fracture the thin medial and inferior walls
the inferior rectus herniates into the maxillary sinus, is trapped, and impairs upgaze resulting in diplopia. Downgaze may also be affected. The eye may be sunken - enophthalmic - and there may be sensory loss corresponding to the area supplied by the infra-orbital nerve
sinus x-rays may reveal bony defects, an air-fluid level in the sinus and herniated soft tissue. The lesion is preferentially visualised by tomography
surgical repair is performed if the diplopia is unlikely to resolve spontaneously, there is severe enophthalmus, or the fracture is so large that the development of enophthalmus is likely
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