Forced Duction Testing for Management of Small Orbital Floor Blowout Fractures

Forced duction testing (FDT) is a diagnostic clinical test of extraocular muscle function employed to confirm the mechanical and restrictive nature of a patient's defective upgaze. Orbital floor blowout fractures (OFBFs) may lead to bony entrapment of the inferior orbital muscles and connective tissue, resulting in restricted vertical gaze and early or late enophthalmos. Management of OFBFs aims to restore normal ocular anatomy and physiology and may require definitive surgical intervention if there is significant entrapment and large fractures. The authors report a 19-year-old man with a small right OFBF due to a rugby football injury, who presented with painful restricted upgaze. High-resolution orbital computed tomography (CT) demonstrated minor impingement of the inferior rectus muscle by the fractured thin orbital floor bone. FDT was performed in the Emergency Department in an attempt to confirm the restricted vertical movement of the involved eye and then to release the impinged inferior rectus muscle. This was achieved immediately and successfully, with rapid resolution of the patient's painful restricted upgaze. Hence, in selected cases of small OFBFs, FDT may have both a diagnostic and effective therapeutic role.