Delayed management of white eye blowout fracture: It's never too late

Anas Imran Arshad, Jawaad Ahmed Asif, Tahir Yusuf Noorani, Nafij Bin Jamayet, Zuliani Mahmood, Mohammad Khursheed Alam

Research output: Contribution to journalJournal articlepeer-review


Background: A classic presentation of a pediatric facial trauma resulting in an orbital blowout fracture is an absence of sub-conjunctival haemorrhage, an upgaze diplopia, and general malaise caused by the oculocardiac reflex (OCR). This clinical presentation is termed as a white eye blow out fracture. These fractures in pediatric patients tend to entrap soft tissues including extraocular muscles leading to limitation in ocular movement. Besides clinical and radiographic evaluations, the motility evaluation is a primary diagnostic tool in such injuries. To prevent a neurocranial injury, early surgical intervention is highly advised in symptomatic cases. Case Presentation: This case report presents a pediatric patient who was involved in a motor vehicle accident and sustained a head injury and an orbital roof fracture. Limitation of extraocular movement, vertical dystopia, OCR and diplopia were observed which suggested a trap door type fracture. To access the surgical site, a coronal approach was performed which facili-tated the release of soft tissues entrapped into the orbital roof. Outcomes: Presence of clinical signs and symptoms like limitation of extraocular movement, vertical dystopia, OCR and dip-lopia are indicative of immediate surgery but concomitant head injury may hinder the urgency of the orbital fracture repair. Although, the surgical correction was delayed satisfactory post-surgical outcomes were achieved with immediate improvement in extraocular movement, diplopia and resolution of OCR. Conclusion: Management of orbital roof fractures is a multidisciplinary approach which requires a prompt execution of treatment plan, good understanding and co-operation between neurosurgery, ophthalmology and maxillofacial team is a necessity for successful outcomes.

Original languageEnglish
Pages (from-to)624-626
Number of pages3
JournalInternational Medical Journal
Issue number5
StatePublished - 2020


  • Diplopia
  • Muscle entrapment
  • Orbital roof fracture
  • Pediatric
  • Trapdoor fracture
  • Trauma
  • White eye blowout fracture


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