Introduction: The orbital roof is involved in about 5% of all facial fractures. Blow-in fractures are defined as inward displacements of a fractured bony orbital wall resulting in decreased orbital volume. This type of fracture may cause proptosis, limitation of eye movement, inferior dystopia of the globe, diplopia and epiphora. Although surgery is not necessary for non-displaced and minimally displaced roof fractures, significant displacement may require early surgical treatment for appropriate orbital decompression.

Case report: A 16 years-old female patient involved in a traffic accident was admitted at Hospital Municipal Mário Gatti, Campinas, State of São Paulo, Brazil. Maxillofacial evaluation was performed 12 days after arrival due to the severity of the associated injuries. The patient presented with a sutured laceration at the forehead, lateral and inferior displacement of the right eye ball with a resulting divergent strabismus. Cerebrospinal fluid leak was not present. CT scans showed undisplaced fractures of the anterior wall of the frontal sinus and a inwardly displaced fracture of the right orbital roof. The patient’s chief complaint was diplopia.

Surgery was performed via the coronal approach, exposing the fracture of anterior wall of the frontal sinus, the orbital rims and the right orbital roof. Reduction of orbital roof fracture and restoration of the orbital volume were accomplished. A titanium mesh kept the fragments in place. Lastly, the anterior sinus wall fracture was reduced and fixed.

During follow-up, divergent strabismus was resolved and did not reappear. Complaints about doubled vision vanished and pre-trauma aesthetics was fully restored.

Conflict of interest: None declared.