Orbital Blowout Fracture Case

Orbital Blowout Fracture Case

Patient

33 yr old male in a high speed roll over MVC. VSS, A&Ox3, complains of Headache and L axillary pain. Physical exam shows an abrasion with superficial lacerations to the axilla. A laceration on the Left hand. He also has bilateral periorbital ecchymosis (black eyes) which he says are from being punched in the R eye several days ago. Differential diagnosis?

ED Course

In the ED, the right eye is normal but appears sunken into the orbit. Extraocular movements are intact. He is tender around the orbit and on the nose which is not bleeding and does not have a septal hematoma.

CT of the head and face showed no intracranial pathology but fractures of the floor and medial portion of the R orbit. Orbital fat is herniating into the sinus. This is called a blowout fracture. The remainder of the trauma work up was negative. He was released on antibiotics and scheduled for outpatient repair of the facial fractures.

Diagnosis

Orbital Blowout Fracture>>