BLOW OUT FRACTURE

Clinical features

Any object more than the size of orbit, when hit orbit result in eyeball transferring the force to orbital wall. The weak walls are orbital floor and medial orbital wall. With fracture of orbital floor, the intraocular contents herniate into maxillary sinus leading to enophthalmos. It also damages maxillary nerve travelling in the floor of orbit. This results in anesthesia below the orbit. 

The inferior rectus muscle may be trapped in herniation to maxillary sinus. This result in diplopia. As the eye cannot move upward. Forced duction test and differential IOP testing will be positive. The saccades will stop abruptly. hess test will show vertical constriction of visual field. 

External signs may include black eye, lid edema and subcutaneous emphysema. 

visual acuity must be assessed in early cases

Investigations

Coronal CT scan will tell us the amount of defect and amount of herniation of orbital contents downward.

Treatment

Its treatment depend upon the severity of condition. Up to half of defect with no herniation of contents downward can be observed. While more than half of defect with herniation of contents downward need repair within two weeks for good results. A subciliary incision is given with elevation of periosteum from orbital floor. The downward herniated tissue is elevated into orbit and defect is repaired with synthetic tissue.

white eyed fracture

This is an emergency occurs in young people and is treatment is required early to prevent neuromuscular damage. The patient experience nause and vomiting. Clinical features are subtle.