A patient presents with enophthalmos after a trauma to face by blunt object. There is no fever or extraocular muscle palsy. Diagnosis is
**Core Concept**
Enophthalmos is a condition characterized by the posterior displacement of the globe of the eye within the orbit, resulting in a sunken appearance. This condition can be caused by a variety of factors, including trauma, orbital fractures, and orbital tumors. In the context of blunt trauma to the face, enophthalmos can be a result of orbital fracture or hemorrhage.
**Why the Correct Answer is Right**
In this scenario, the patient's enophthalmos is likely due to a blowout fracture of the orbital floor. This type of fracture occurs when there is a sudden increase in orbital pressure, such as during a blunt trauma to the face, causing the orbital floor to fracture and allowing the orbital contents to herniate into the maxillary sinus. The absence of fever or extraocular muscle palsy suggests that the fracture is not complicated by an orbital hematoma or abscess. The orbital floor is composed of thin bone, which is more susceptible to fracture than the thicker bones of the orbital rim.
**Why Each Wrong Option is Incorrect**
**Option A:** Zygomatic arch fracture - While a zygomatic arch fracture can result in enophthalmos, it is less likely to cause the posterior displacement of the globe seen in a blowout fracture.
**Option B:** Orbital cellulitis - This condition would likely present with signs of infection, such as fever and swelling, which are not present in this case.
**Option C:** Orbital hemorrhage - While an orbital hemorrhage can cause enophthalmos, it is typically accompanied by signs of increased intracranial pressure, such as headache and pupillary abnormalities.
**Clinical Pearl / High-Yield Fact**
A blowout fracture of the orbital floor is a common cause of enophthalmos after blunt trauma to the face. It is essential to obtain a detailed history and perform a thorough examination to differentiate this condition from other causes of enophthalmos.
**Correct Answer:** C. Orbital hemorrhage