During a baseball game, the pitcher is hit in the left eye with a hard-hit line drive. He is rushed to the nearest emergency department where CT scan reveals left orbital rim and floor fractures and fluid in the left maxillary sinus. What are physical findings likely to include?
**Core Concept**
The patient has sustained a traumatic injury to the left orbit, resulting in fractures to the orbital rim and floor. This type of injury can cause damage to the surrounding structures, including the maxillary sinus, and lead to specific physical findings.
**Why the Correct Answer is Right**
The physical findings in this patient are likely to include enophthalmos, a posterior displacement of the globe into the orbit, due to the fracture of the orbital floor. This allows the orbital contents to herniate into the maxillary sinus, causing a decrease in the volume of the orbit and a sense of the eye being sunk into the orbit. Additionally, there may be telecanthus, a widening of the intercanthal distance, due to the swelling and bruising of the surrounding tissues. Other findings may include periorbital edema, ecchymosis, and limited upward gaze due to the entrapment of the inferior rectus muscle within the maxillary sinus.
**Why Each Wrong Option is Incorrect**
**Option A:** Ectropion is the outward turning of the eyelid, which is not a typical finding in orbital fractures. This option is incorrect because the patient's eyelid is not likely to be everted due to the injury.
**Option B:** Exophthalmos is the forward protrusion of the globe, which is the opposite of what is expected in this case. This option is incorrect because the patient's eye is not likely to be protruding due to the orbital floor fracture.
**Option C:** Ptosis is the drooping of the eyelid, which is not a direct consequence of orbital fractures. This option is incorrect because the patient's eyelid is not likely to be drooping due to the injury.
**Clinical Pearl / High-Yield Fact**
In cases of orbital fractures, it is essential to assess for entrapment of the orbital contents, particularly the inferior rectus muscle, which can lead to limited upward gaze and enophthalmos.
**Correct Answer:** C. Telecanthus, enophthalmos, and periorbital edema.