COW - Case of the WeekMedPix® Home PageTeaching File Case - Patient: 13301
Peer Reviewed and Certified - Approved by: James G. Smirniotopoulos, M.D. - 2009-11-02 15:21:23-05
Submitted by: Steven J Goldstein - Author Info
Affiliation: University of Kentucky
Approved By: James G. Smirniotopoulos, M.D. - Editor Info
Affiliation: Uniformed Services University
::::::TF Case Summary::::::Print TF Case::
Demographics: 23 y.o. woman
History & Chief complaint:
23 year old woman who came to the ER after falling from a horse.
 
Physical exam and Laboratory:
Soft Tissue Swelling right orbit.
No muscle entrapment (EOMs normal)
 
Click on Thumbnail Image to Magnify

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Magnify Orbital Floor Fracture
Figure 1
Orbital Floor Fracture
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Figure 2
Orbital Floor Fracture
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Figure 3
Orbital Floor Fracture
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Figure 4
Orbital Floor Fracture

 
Summary of Findings:
• Orbital floor fracture on right.
• Air-fluid level right maxillary sinus.
 
Differential Diagnosis:


 
Diagnosis:
More Like This ?   Blowout fracture of orbit
Confirmed by: CT scan
Treatment and Followup:
None required.
 
Disease Discussion -  Blowout fracture of orbit
Discussion Author: James G. Smirniotopoulos, M.D.
When an object of large diameter (greater than 4-5 cm) like a fist or a baseball, strikes the orbit, forces may be transmitted through increased intra-orbital pressure. When there is increased pressure in the orbit, the thinnest bones break first, and the orbital contents may herniate through the fracture. This is the so-called "Blow-out Fracture". Typically, the floor of the orbit, parts of the medial wall (lamina papyracea) and rarely the orbital roof may "blowout".

Clinical signs of entrapment (abnormal EOM's with restricted upward gaze) and enophthalmos (retraction of the eyeball) may occur.

Complications of Blow-Out Fx:
Pneumo-orbita
Cellulitis and Abscess
Diplopia and Restricted EOM's

Blunt force trauma (e.g. Ball or fist)
Hydraulic (pressure) forces increased intra-orbital pressure
Fractures thin bones
Floor (orbital process of maxilla)
Medial (20-50%) (lacrimal and ethmoid)
Herniation and entrapment of orbital fat & EOM (inf. Oblique)

The literature continues to emphasize this "Hydraulic Theory" over the alternative hypothesis of direct transmission of forces from the orbital rim and/or the globe itself.
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