Which of the following is NOT a finding associated with an orbital fracture?

• A. Skew deviation
• B. Pain
• C. Binocular diplopia
• D. Crepitus

Answer: (A)

The important idea here is recognizing the typical local signs of an orbital fracture. Pain and binocular diplopia are common because trauma can disrupt eye movements and the soft tissues around the eye, leading to misalignment and double vision. Crepitus, a crackling sensation under the skin, can occur when air from the sinus tracks into the orbital tissues after a floor or wall fracture.

Skew deviation, on the other hand, is a vertical misalignment usually arising from central nervous system or vestibular/brainstem problems, not from injury confined to the orbit. Therefore, it is not a typical finding of an orbital fracture. If skew deviation is present after trauma, it should prompt evaluation for a central cause in addition to evaluating the orbit.