The White-Eyed Blowout fracture in the child: beware of distractions

Hammond, Douglas, Grew, N and Khan, Z (2013) The White-Eyed Blowout fracture in the child: beware of distractions. Journal of Surgical Case Reports, 2013 (7). rjt054. ISSN 2042-8812

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Inferior ‘trapdoor’ orbital floor fractures with muscle and soft tissue incarceration are the most
common type of orbital fracture in children. Delays to treatment can lead to a significant morbidity.
It has been recommended that children who present with a ‘white-eyed blowout’ fracture should have surgery performed within 48 h of diagnosis, otherwise prognosis is poor. A 14-year-old boy was initially misdiagnosed with a head injury due to the minor appearance of his orbital injury and his presenting complaint of nausea and vomiting. This resulted in a significant
delay to surgery. The oculovagal reflex associated with orbital injuries is well documented (Wei and Durairaj in Pediatric orbital floor fractures. J AAPOS 2011;15:173–80). It should be considered by emergency department and paediatric staff when dealing with patients who have sustained a blow to the orbital region, despite not having a subconjunctival haemorrhage. The importance of examination to detect other features of orbital blow-out and entrapment are stressed.

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