Ptosis and levator paralysis caused by orbital roof fractures. Three cases with subfrontal epidural hematomas.

Blows to the forehead resulted in orbital roof fractures and subfrontal epidural hemorrhage in three patients. Neurologic eye signs were limited to ipsilateral paralysis of globe and lid elevation. In the context of an ecchymotic upper lid, these findings indicate local damage to orbital muscles rather than injury to the superior division of the third nerve. Even when such patients are alert, prompt computed tomographic (CT) scanning of the head should be undertaken to rule out an enlarging epidural hematoma.