Orbital floor fracture with ruptured globe

Case contributed by Dr Smita Deb

Presentation

Alleged assault with marked peri-orbital haematoma and decreased visual acuity.

Patient Data

Age: 48
Gender: Female

There is a right orbital floor blowout fracture entrapping the inferior rectus. It involves the lens and orbital fat and is associated with a right maxillary sinus haemorrhage.

Gross tissue haemorrhage surrounds the right orbit with blood also within the partly collapsed right globe. There is marked architectural distortion of the globe. The optic nerve is intact.

Case Discussion

Mid-facial injuries can cause neurovascular damage to the eye. The medial and inferior orbital walls are commonly involved in blowout fractures and occur due to high pressures secondary to globe compression. The orbital walls commonly break outwards resulting in herniation of fat and extra-ocular muscles. These fractures may thus present with ocular symptoms such as diplopia and enophthalmus, requiring ophthalmology review 1.

The patient's ruptured globe was repaired surgically by ophthalmology and she has ongoing plastic surgery follow up regarding facial fracture management.

The fracture was not repaired surgically initially due to the ocular emergency, inflammation and swelling and uncertainty regarding function of the globe.

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Case information

rID: 33272
Case created: 6th Jan 2015
Last edited: 26th Nov 2015
Inclusion in quiz mode: Included

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