A careful examination of the globe is mandatory in all cases of injury to the orbit. If so, a lateral canthotomy and cantholysis of the inferior crus of the lateral canthal tendon should be performed. The incision should be made with sharp scissors, and blunt tip scissors should be used to gently spread the orbital fat within the muscle cone to permit the escape of blood. Pressure on the globe and optic nerve during any surgery upon the orbit and its contents must be avoided.
Blindness can result from prolonged retraction pressure on the globe and nerve.
Radiographic evaluation of orbital fractures should include a stereo Waters' view and computerized tomography with coronal and sagittal reformatting. The latter is especially important in the evaluation of fractures of the optic canal. Blowout fractures of the orbital floor in general do not require immediate repair. Forced duction testing should always be performed before resorting to surgical repair. If surgery is performed, ductions of the globe should be tested intraoperatively to help prevent incarceration. of tissues incident to surgical manipulation.