Orbital medial wall and floor blowout fracture

Case contributed by Yaïr Glick


Got hit in the eye by a wood plank.

Patient Data

Age: 40 years
Gender: Male

No evidence of intracranial bleed (brain window not shown).
Right periorbital hematoma. Right orbital blowout fractures of the lamina papyracea and the orbital floor. Entrapment of the right extraocular inferior rectus muscle along with inferior herniation of retrobulbar fat. Right orbital emphysema, most of it retrobulbar intraconal, with slight medialization of the optic nerve. No enophthalmos or exophthalmos.

Case Discussion

The medial orbital wall and the orbital floor are weaker than the upper and lateral walls, and are therefore more prone to fracture when the orbit is dealt a substantial blow.
In this case, there is entrapment of the inferior rectus muscle and retrobulbar fat between collapsed bone fragments of the orbital floor.
Entrapment of an extraocular muscle and/or retrobulbar fat can result in diplopia and even an oculocardiac reflex (i.e. bradycardia, nausea, and vomiting), warranting prompt surgery 1.

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