orbital roof fracture is suspected Plain radiographs have little role in the management of orbital wall fractures as they lack sensitivity The necessity and timing of surgical intervention is controversial; however, most agree that significant extraocular restriction or persistent vomiting necessitates surgical intervention Orbital hemorrhage can lead to orbital compartment syndrome Retrobulbar hemorrhage can cause central retinal artery hypertension or even occlusion Vision loss, severe pain, and proptosis suggest retrobulbar hemorrhage A high suspicion or established diagnosis of such symptomatic hemorrhages necessitates emergent lateral canthotomy and cantholysis by a trained emergency provider or surgeon ( Fig 114.8 ) EYELID LACERATIONS CLINICAL PEARLS AND PITFALLS The following findings require ophthalmology consultation: fullthickness laceration of the eyelid, ptosis, orbital fat prolapse, eyelid margin involvement, injury in close proximity to the tear duct system, tissue avulsion, and concurrent globe injury ( Table 114.3 ) Current Evidence Simple eyelid lacerations may be managed by emergency providers with standard wound care techniques; however, it is standard of care to initiate prompt ophthalmology consultation when deeper injuries are suspected Goals of Treatment Similar to other lacerations, the primary goal is wound closure to achieve hemostasis, cosmesis, and prevent infection Emergency providers may repair simple lacerations of the eyelid and surrounding area using standard wound closure methods However, those lacerations requiring further evaluation for possible injury to the eye itself, tear ducts, or other key structures or those requiring surgical expertise should be promptly recognized Clinical Considerations Clinical Recognition Although eyelid lacerations are usually easy to detect, the clinician must remember that the underlying globe might also have been lacerated or injured Seemingly superficial lacerations of the eyelid may be associated with penetration into the orbit or intracranial cavity, particularly when a pointed implement caused