Abstract
The ‘white-eyed’ blowout fracture (WEBOF) is an injury that is often overlooked in head trauma patients, as it often has few overt clinical and radiographic features. Although benign in appearance, it can lead to significant patient morbidity. Here, we intend to increase the awareness of WEBOF and provide general principles for its diagnosis. WEBOF should be recognized early to ensure timely management and a successful outcome.
Highlights
BackgroundOrbital wall fractures can lead to serious patient morbidity, including the oculocardiac reflex, diplopia, enophthalmos, hypoglobus, infraorbital nerve paresthesia, and ophthalmoplegia [1]
Jordan et al were the first to report that orbital fractures may lack external signs of injury, and coined the term white-eyed blowout fracture (WEBOF) in 1998 [3]
Considering that most of these missed injuries presented with autonomic symptoms, WEBOF should be included in the differential diagnosis for head trauma patients who present with bradycardia and/or a recent history of nausea or vomiting
Summary
Orbital wall fractures can lead to serious patient morbidity, including the oculocardiac reflex ( known as Aschner phenomenon or trigeminocardiac reflex), diplopia, enophthalmos, hypoglobus, infraorbital nerve paresthesia, and ophthalmoplegia [1]. Mehanna et al reported a 21-year-old man with WEBOF that underwent surgery six days after the injury [9] This patient continued to have extraocular muscle paresis, despite satisfactory postoperative computed tomography of the maxillofacial bones (CTMF). Considering that most of these missed injuries presented with autonomic symptoms, WEBOF should be included in the differential diagnosis for head trauma patients who present with bradycardia and/or a recent history of nausea or vomiting. We recommend that all patients with a recent history of head trauma undergo a close examination of the orbits, including evaluation of periorbital tissues, infraorbital nerve function, pain on palpation, pulse rate on attempted gaze, ocular motility, visual acuity, visual fields, and pupillary responses to rule out injury to the orbit (Figure 2) [34]. CTMF: Computed tomography of the maxillofacial bones; IOP: Intraocular pressure; RAPD: Relative afferent pupillary defect
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