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Emergency: requires immediate attention
Blow-out fracture of orbit - External and Internal Eye
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Emergency: requires immediate attention

Blow-out fracture of orbit - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Lauren Patty Daskivich MD, MSHS, Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD
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Synopsis

After sustaining a blunt force injury with an object larger in size than the globe, such as a fist or ball, the orbit is at risk of a "blow-out fracture." Although the lamina papyracea is the thinnest bone of the orbit, the orbital floor is the most common type of orbital fracture. This type of fracture tends to occur just behind the orbital rim but may involve the rim itself. 

Patients often present with pain and tenderness to the periorbital region, which may worsen on attempted upgaze. They may note diplopia if there is limited motility of the involved eye. Signs of orbital floor blow-out fracture may include ecchymosis, enophthalmos, hypesthesia of the cheek, crepitus, and restricted eye movements, particularly in upgaze. 

As the swelling decreases with time after the trauma, enophthalmos becomes more apparent in larger fractures. In many orbital fractures, swelling and ecchymosis are the only signs. 

Pediatric Patient Considerations: 
Children are at an increased risk of severe muscle entrapment of the inferior rectus with associated nausea and vomiting. This type of entrapment is considered a surgical emergency, as the tissue can become ischemic if not released.

Codes

ICD10CM:
S02.30XA – Fracture of orbital floor, unspecified side, initial encounter for closed fracture
S02.30XB – Fracture of orbital floor, unspecified side, initial encounter for open fracture

SNOMEDCT:
263167007 – Blow out fracture of orbit

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Orbital contusion 
  • Orbital fracture without blowout

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 08/23/2013
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Emergency: requires immediate attention
Blow-out fracture of orbit - External and Internal Eye
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View all Images (9)
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Blow-out fracture of orbit : Eye pain, Diplopia, Enophthalmos, Eyelid edema, Eyelid ptosis, Periorbital edema, Ecchymosis, HR decreased
Imaging Studies image of Blow-out fracture of orbit
Axial CT sequence demonstrates a depressed fracture of the inferior wall of the orbit. On soft tissue windows there is a small left maxillary hemosinus.
Copyright © 2019 VisualDx®. All rights reserved.