9/18/2023 0 Comments Blowout fracture![]() ![]() Rarely asystole or cardiac arrythmia may also occur. Additionally, with attempted ductions the patient may vomit and/or become bradycardic. The patient often has her/his eyes closed due to induced nausea and diplopia from restriction in motility, generally vertically. The external signs can be absent or quite subtle, as the name suggests. Enophthalmos is uncommon or not that obvious especially in an uncooperative child while the rest of the ocular examination, including full dilated examination, is unremarkable. There may or may not be decreased sensation due to infraorbital nerve injury. This may be accompanied by nausea and vomiting, due to the oculocardiac reflex, and/or pain with motility. With dedicated ocular motility examination there is marked limitation of gaze (up gaze for inferior rectus, lateral gaze for medial rectus). ![]() Patients may preferentially avoid eye opening or looking up (floor fracture) to avoid nausea or pain. On examination, patients often have an unremarkable external examination with a paucity of periorbital bruising and/or swelling as the name "white eyed" implies. bruising) and even possibly a reportedly "normal" CT scan of the brain, which may miss orbital floor cuts. There may be a delay in presentation due to the lack of significant external findings (e.g. These fractures occur in a younger age demographic in the setting of recent trauma although not always reported especially in young children. They may then be suspected to have an intracranial injury and managed accordingly instead of appropriate and early intervention for the orbital fracture. Cases are often misdiagnosed as these children may present with a history of blunt injury or none at all with vagal phenomenon upon attempted up gaze (floor fractures). Radiographic studies especially x-rays or CT scan of the brain can overlook the small, non-displaced fracture. WEBOFs are generally diagnosed based on the history, high degree of suspicion and focused clinical examination. General safety guidelines to prevent trauma and activity specific sports eye wear are recommended. Most often these are isolated fractures, with or without concomitant intraocular injury(ies). Typically involving the floor and thus the inferior rectus muscle it may affect the medial wall and the medial rectus far less frequently. This incarcerated tissue can be orbital fat with intermusculear septum and/or an extraocular muscle. This trapdoor of bone can then snap back towards its original position when the pressure on the orbital tissue has decreased, capturing the orbital soft tissue in the process. Due to the less calcified, more flexible bone seen in the pediatric population, the bone can crack and open as if on a hinge. This expansion puts pressure on the orbital bones and can lead to a break in one of the weaker areas of bones, most commonly the orbital floor. The theoretical pathophysiology is of a force applied to the eye/orbital rim transmitting forces to the orbit and an equatorial expansion of the intraorbital tissue. WEBOFs are usually caused by blunt force injury to the eye and/or orbital rim typically by a blunt object larger than the side of the orbital entrance. Pediatric age group and male gender are more prone to WEBOFs although it may be seen in young adults as well with an average age of less than 10 years. White-eyed blow out fracture (WEBOF) is a term coined by Jordan and colleagues describing the paucity of external findings with a small fracture and restrictive strabismus and diplopia and is most commonly seen in children and young adults. The trauma can be a direct or glancing blow to the eye and/or periorbital tissue and commonly occurs during sporting activities. S02.40, S02.32) and restricted motility/diplopia codes.Ī WEBOF is a type of blow out orbital fracture with orbital soft tissue herniation, which is often but not always associated with an entrapped extraocular muscle-inter muscular septum (EOM-IMS) complex which may result in restrictive strabismus and vasovagal phenomenon especially in young children.Īs with other fractures, a WEBOF is due to trauma. There is usually no periorbital ecchymosis or subconjunctival hemorrhage. White-eyed blow out fracture (WEBOF) is a term for a single or multiple wall orbital fracture with intact orbital rim, with herniation and with/without entrapment and restrictive strabismus and a clinically quiet 'white' eye'. ![]()
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