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We advocate forced duction testing only on a limited basis, under anesthesia if possible, and only if the findings will significantly change clinical or surgical management. Additionally, forced ductions are extremely uncomfortable with a patient who is awake. Forced duction testing, however, may be misleading in the acute post trauma setting due to hemorrhage and edema. Once the globe is deemed intact and stable, some advocate forced duction testing in the assessment of eye movement problems. Although radiographic imaging can be used to evaluate for muscle involvement, muscle entrapment is a clinical diagnosis. Posttraumatic dysmotility may also ensue from direct muscle damage or edema and nerve damage. Orbital tissue edema and muscle entrapment are common etiologies as is the loss of wall support ( Table 2 Figs. Restricted extraocular muscle movements may be present due to multiple mechanisms. Point tenderness or step-offs along the orbital rim may be noted in the location of a possible fracture involving the orbital rim. Crepitus may be noted if air from the sinuses has tracked into the subcutaneous tissues after nose blowing or sneezing. Varying degrees of periorbital ecchymosis and edema are typical after trauma. There are several common clinical exam findings, regardless of the etiology of the fractures, suggestive of an orbital fracture ( Table 1). Coronal computed tomography images of the obits showing a left inferior orbital wall fracture ( A) and irregularity of the nasal globe contour of the left eye ( B) suggesting a globe rupture.