Laceration of the Globe due to a Blow-out Fracture

We present a case of an inferior orbital blow-out fracture that is unusual in both the nature of the severe ocular injury and the surprising lack of findings that would suggest such an injury to a nonophthalmologist. Report of a Case. —A 22-year-old white man was struck with a fist in his right eye. He did not seek medical attention initially and when his lid swelling decreased he began to notice diplopia along with floaters and photopsia. On examination, the patient's best visual acuity was 20/30+. He was unable to either supraduct or infraduct the globe and there was numbness in the distribution of the infraorbital nerve. Results of the anterior segment examination were normal with no evidence of blunt trauma. However, the funduscopic examination revealed a 2-disc-diameter tear in the inferior retina just posterior to the equator. Beneath the tear the choroid was ruptured, with bare sclera visible (Figure).