Due to acute edema and hemorrhage, exophthalmos can be present prior enophthalmos. The exam in this case reveals a step-off and point tenderness along the infraorbital rim. In “blow-in” fractures, the inferior rim is fractured, typically as part of a zygomaticomaxillary complex fracture. In orbital “blow-out” fractures, the inferior orbital rim remains intact. Pathognomonic clinical findings are diplopia, restricted eye movement, decreased periocular sensation, subcutaneous emphysema, and globe dystopia, typically but not always associated with chemosis and ecchymosis ( 3). They are more common in males, age 21–31, usually as a result of a fall, motor vehicle accident, or an assault ( 2). Fractures can be isolated or combined with other non-orbital fractures ( 1). The most common orbital fracture sites involve the inferior and medial walls along the thinnest bony areas. This approach was effective, providing excellent exposure while reducing the risks of lower eyelid retraction and surgical scars associated with the transcutaneous approach. Surgery was performed under general anesthesia using the transconjunctival approach and an alloplastic implant. Following neurosurgical stabilization, she was referred to ophthalmology with pronounced hypoglobus and enophthalmos, diplopia, relative afferent pupillary defect, and a slightly pale right optic nerve head. An acute repair was performed by a maxillofacial team to stabilize the facial structure. A 19-year-old female patient had fallen from a 5-meter-high fence and sustained panfacial fractures, including both orbits and the surrounding sinuses. This report is a description of an illustrative case and a brief summary of the literature related to the transconjunctival approach to orbital floor fracture repair as performed by ophthalmologists. Several surgical approaches for repair have been described in the literature. Water’s View Skull X-Ray (Tintinalli et al.A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enophthalmos, hypoglobus, or strabismic diplopia.Can see signs of eye emergencies such as globe rupture, retrobulbar hematoma, and entrapment in addition to the fracture itself.If there is high suspicion for orbital fracture based on exam, facial or orbital bone CT scan should be obtained as non-contrast head CT can miss a significant portion of facial fractures (Huang et al., 2017).Can be seen with medial wall fractures, particularly with nose blowing.Due to injury to Maxillary Branch of Trigeminal Nerve (V2).Diplopia on upward gaze is often seen in fractures of the inferior wall due to entrapment of inferior rectus, inferior oblique.Proptosis – Seen in retrobulbar hematoma.Enophthalmos – Early finding which precedes tissue edema.Tear drop pupil should raise concern for globe rupture.Visual acuity is the most important measure of eye function. ![]() ![]()
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