White‐eyed blowout fracture: Another look

Abstract

Orbital floor fractures have the potential to cause significant morbidity both in the short and long terms and commonly present to the ED for initial assessment. Although treatment of the majority of these injuries involves clinic review and possible later surgery, there is a specific subset that present to emergency clinically suggestive of a head injury. This subset, 'white-eyed blowout', usually occurring under 18 years of age, with a history of trauma and little sign of soft tissue injury, describes a trap door orbital floor fracture with herniation and acute entrapment of orbital muscle and is regarded as a maxillofacial emergency. The injury presents with marked nausea, vomiting, headache and irritability suggestive of a head injury that commonly distracts from the true aetiology. It requires prompt diagnosis and treatment to avoid permanent morbidity. We present three cases and discuss their management.

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis

“…Orbital floor fractures can present in isolation or in combination with other facial fractures. The etiology is usually direct trauma to the orbital region resulting in fracture to the orbital floor 1 . The fracture pattern is usually an "open door" defect and is typically seen in adults with herniation of the orbital contents into the maxillary sinus.…”

The ‘White-eyed’ Orbital Blowout Fracture: An Easily Overlooked Injury in Maxillofacial Trauma

“…Ethunandan and Evans reported seven cases of WEBOFs, of which one was a 29-year-old [8]. Mehanna et al reported a 21-year-old man with WEBOF that underwent surgery six days after the injury [9]. This patient continued to have extraocular muscle paresis, despite satisfactory postoperative computed tomography of the maxillofacial bones (CTMF).…”

“…Fortunately, oculocardiac symptoms resolved and the patient regained full ocular motility postoperatively. Mehanna et al reported three cases of WEBOF, of which one was initially mistaken for a head injury and another was completely missed [9]. Regrettably, the patient with the missed orbital fracture exhibited persistent extraocular muscle paresis despite adequate surgical reconstruction and no muscle impingement evident on postoperative CTMF.…”

“…Yew et al reported a case of WEBOF in which the boy vomited twice after the injury [6]. Mehanna et al reported three cases of WEBOF that all presented with symptoms of nausea [9]. Heggie et al reported 22 cases of isolated blowout fractures, in which 10 presented with nausea and vomiting [22].…”

Akuter Strabismus im Kindesalter

“…Eine neuroradiologische Untersuchung sollte jedoch in jedem Fall bei zusätzlichen Symptomen wie einer Papillenschwellung, Pupillenstörung, Nystagmus oder weiteren neurologischen Symptomen erfolgen (▶ Abb. 2a-c) (21).…”