What indicates a surgical emergency in an orbital fracture?

The presence of double vision (diplopia) during eye movement is indicative of a surgical emergency in the context of an orbital fracture because it suggests that there may be dysfunction of the extraocular muscles or nerve entrapment. Orbital fractures can lead to complications such asocular muscle entrapment or damage to the optic nerve, which can have immediate and significant implications for the patient's vision. When a patient experiences double vision, it signals that one or more of the muscles responsible for eye movement may be compromised or caught in the fracture, leading to misalignment of the eyes.

Bruising around the eye, while often present in cases of orbital fractures, does not themselves signify the urgency of a surgical intervention. Similarly, pain when closing the eye may indicate discomfort but does not necessarily correlate with critical damage or emergency conditions. The presence of a blood clot behind the eye can be concerning but does not immediately indicate a surgical necessity compared to the urgent condition represented by double vision. Therefore, the most pressing sign that warrants exploration and potential surgical intervention is the presence of double vision with eye movement.