Orbital blowout and retro-orbital hematoma

Case contributed by Dr Derek Smith


Assaulted. Two punches to left eye. Tender left zygoma, "watery blood" coming from nose. Proptosis of left eye with reduced acuity to hand movements and RAPD on the left.

Patient Data

Age: 50 years
Gender: Male

XR facial bones

Multiple facial fractures:

  • displaced fracture of the left zygomatic arch
  • diastasis of the left frontozygomatic suture
  • inferior wall of the left orbit
  • left anterior maxillary antrum

Opacification of the left maxillary sinus. No mandibular fractures.


CT facial bones

See CT head report for soft tissue findings.

No skull base fracture.

Multiple facial fractures:

  • two minimally displaced fractures of the left zygomatic arch
  • displaced fractures of the medial, anterior and lateral walls of the left maxillary sinus
  • displaced fractures of the medial, lateral and inferior orbital margins
  • multiple nasal bridge fractures
  • cribriform plate appears intact

See facial bone CT for report on fractures.

Main finding is 27mm acute hematoma within the inferior left retro-orbital space extending into the left maxillary sinus causing superior, lateral and anterior displacement of the globe. The inferior rectus muscle is not clearly visualized. Optic nerve appears to be intact.

The left maxillary sinus is filled with blood.

No intra-cranial injury.

Soft tissue swelling with flecks of gas in the tissues.

Case Discussion

This patient had an emergency lateral canthotomy performed by the ophthalmogists to preserve vision in his left eye as there was concern about optic nerve compression. His fractures were managed by the maxillofacial surgeons.


Many thanks to the patient for his consent to use these images for teaching purposes.

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Case information

rID: 35549
Published: 10th Apr 2015
Last edited: 9th Dec 2020
Inclusion in quiz mode: Included

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