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Keywords:
White-eyed blowout fracture, diplopia, ocular motility restriction, tissue entrapment
Abstract
A white-eyed blowout fracture is an orbital floor fracture associated with restriction of ocular motility (suggestive of orbital content entrapment) but with minimal or absence of signs of soft tissue trauma. It can lead to significant patient morbidity. This case involved an 8-year-old boy with a white-eyed blowout fracture following facial trauma. He presented with binocular diplopia and a history of recurrent episodes of vomiting after the trauma and was referred to our centre for a suspected head injury. Visual acuity in both eyes was 6/9. Examination showed minimal left periorbital haematoma with left eye motility restriction on superior and medial gaze associated with pain. CT scan of the orbit showed left orbital floor fracture with minimal soft tissue entrapment. He underwent urgent open exploration of the left orbit and release of orbital tissue entrapment. Post-operatively, the left eye motility restriction improved significantly with resolution of diplopia. In conclusion, a high index of suspicion is crucial in diagnosing paediatric white-eyed blowout fractures due to lack of external ocular signs.
Introduction
Smith and Regan et al. first described a blowout fracture - an isolated fracture of the orbital floor with an intact orbital rim - in 1957.1 In 1998, Jordan et al. introduced the term whiteeyed blowout fracture, referring to individuals presenting with ocular symptoms following a blow to the periocular area, although with minimal signs of soft tissue trauma.2,3 Paediatric white-eyed blowout fractures are rare and can present differently, thus offering potential for long-term complications if not recognised and treated properly.4 This article reports the case of a young boy with a white-eyed blowout fracture following facial trauma.
Case history
A healthy 8-year-old boy allegedly fell into a drain with the left side of his face hitting the drain's edge. There was no loss of consciousness. However, he had binocular diplopia and several episodes of vomiting after the trauma. There was no history of headache, drooping of the eyelid or sunken globe. He was referred to our emergency department for suspected head injury due to persistent vomiting.
His Glasgow Coma Scale remained full throughout admission, and he was haemodynamically stable. His visual acuity was 6/9 in both eyes. Pupillary reaction was normal in...