Presentation
A case of direct trauma to left orbit presenting with remarkable preseptal soft tissue swelling. Because of limitations in clinical examination due to above mentioned preseptal soft tissue swelling the patient underwent non-contrast orbital MDCT.
Patient Data
Caudally displaced comminuted fracture in left orbit floor with remarkable hemorrhage within left maxillary sinus antrum and hematoma within the fat encased the inferior rectus muscle (IRM) and prolapse of the IRM within the floor fracture defect.
Note the hemorrhage within the left ethmoid sinus and minimally displaced fracture in left orbit anterior medial wall and also infero-nasal entrapment of the medial rectus muscle fascia best seen on coronal views.
Inflammatory change and foci of lacerations and hematoma within orbit intraconal fat are seen. Note also dislocated lens of the left eye within posterior vitreous. There is also proptosis of left eye on sagittal view. There is not any gross or obvious retrobulbar hemorrhage or optic canal fracture in this case.
Case Discussion
The imaging modality of choice for screening the orbital wall blow out fracture is orbital MDCT with multiplanar reconstruction and the best MDCT views for orbital floor blow out fracture evaluation are coronal and sagittal views and for medial wall blow out fracture evaluation are coronal and axial views.
The position of extraocular muscles and orbital fat relative to the orbital blow out fracture, presence of optic canal injury and presence of retrobulbar hemorrhage are critical and clinically applicable that must be always evaluated on MDCT of the orbits and reported.
Nowadays simple X-ray have no role in orbital wall fractures evaluation and the best indication for orbit MRI is for optic nerve evaluation and intracranial insults if there is any suspicious for traumatic optic neuropathy or brain injury.
The best time for repairing the fractures is at least 6 weeks after the acute setting of the orbital trauma for achieving the best outcome.
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