|Year : 2019 | Volume
| Issue : 3 | Page : 256
White eyed blowout fracture of orbit in elderly patient - An unusual presentation
V Muthukrishnan, R Senthil Prasad, Juhi Sahu, Shravya Choudhary Balla
Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
|Date of Submission||22-Mar-2019|
|Date of Acceptance||09-Jun-2019|
|Date of Web Publication||11-Nov-2019|
Dr. V Muthukrishnan
Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Muthukrishnan V, Prasad R S, Sahu J, Balla SC. White eyed blowout fracture of orbit in elderly patient - An unusual presentation. TNOA J Ophthalmic Sci Res 2019;57:256
|How to cite this URL:|
Muthukrishnan V, Prasad R S, Sahu J, Balla SC. White eyed blowout fracture of orbit in elderly patient - An unusual presentation. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2019 Dec 12];57:256. Available from: http://www.tnoajosr.com/text.asp?2019/57/3/256/270688
Trapdoor fractures are also known as “white-eyed blowout fractures (WEBOFs)” or “linear nondisplaced” fractures. They are most common in children and are defined by the lack of displacement of the bones involved. In children, bones are composed of a higher proportion of osteocytes than osteoblasts and thus a smaller amount of calcified osseous tissue, allowing them to be more pliant. In contrast, the less elastic nature of adult bone is more likely to result in comminuted fractures. Although much less common, trapdoor fractures can occur in adults. Trapdoor fracture has been documented in literature in a 37-year-old patient. We report a rare case of WEBOF of the floor of the orbit in an elderly female.
A 65-year-old female presented with blunt trauma to the right eye followed by pain on elevation. She denied a history of diplopia, nausea, or vomiting. Anteriorsegment examination was normal except for restriction of elevation in the right eye [Figure 1]a, [Figure 1]b, [Figure 1]c. Computed tomography scan revealed a linear undisplaced fracture line in the floor of the right orbit and impingement of the inferior rectus muscle [Figure 1]d. The patient was treated with oral steroids. On follow-up after 2 weeks, recovery of extraocular movements to near normal was observed.
|Figure 1: Composite image showing (a) Primary gaze, (b and c) Defective elevation and laevo-elevation of the right eye, (d) Computed tomography scan image showing fracture floor of the right orbit with entrapment of the inferior rectus muscle|
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This case highlights a rare presentation of WEBOF in an elderly patient. Oculocardiac reflex may be absent in adults. In patients with orbital trapdoor fractures, no apparent clinical or radiographic finding may be present apart from an abnormal ocular motility. WEBOF should be considered in cases of blunt trauma in elderly patients presenting with white eye and restricted extraocular movements. Conservative treatment with systemic steroids may be beneficial.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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Phan LT, Jordan Piluek W, McCulley TJ. Orbital trapdoor fractures. Saudi J Ophthalmol 2012;26:277-82.