Blowout fracture

• A blowout fracture typically involves blunt force trauma from an object greater than 5cm in size (e.g. a fist).
• The sudden increase in intraorbital pressure from such injuries creates a fracture of the relatively thin bones of the orbital floor and sometimes the medial wall.
• There may be associated injury to the globe - bruising, oedema and enophthalmos
• Diplopia occurs due to restriction in extraocular muscle involvement
• CT is the imaging of choice to aid visualisation of the extent of bony fractures, prolapse of soft tissues and extraocular muscle entrapment.
• Management:

  • Conservative - ice packs and nasal decongestants
  • Patients should not blow their nose for 4-6 weeks
  • Severe sight threatening swelling may require steroids
  • Surgical repair if non-resolving diplopia or severe enophthalmos
• Periocular bruising and orbital floor fracture is a common presenting feature of intimate partner violence.
• Severe blunt force injury to the globe may result in a globe rupture - may lead to a haemorrhage in the anterior chamber with a fluid level known as hyphaema