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Year : 2019  |  Volume : 57  |  Issue : 3  |  Page : 256

White eyed blowout fracture of orbit in elderly patient - An unusual presentation


Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India

Date of Submission22-Mar-2019
Date of Acceptance09-Jun-2019
Date of Web Publication11-Nov-2019

Correspondence Address:
Dr. V Muthukrishnan
Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_32_19

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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.[1] 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.[2] Although much less common, trapdoor fractures can occur in adults. Trapdoor fracture has been documented in literature in a 37-year-old patient.[2] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hammond D, Grew N, Khan Z. The white-eyed blowout fracture in the child: Beware of distractions. J Surg Case Rep 2013;2013. pii: rjt054.  Back to cited text no. 1
    
2.
Phan LT, Jordan Piluek W, McCulley TJ. Orbital trapdoor fractures. Saudi J Ophthalmol 2012;26:277-82.  Back to cited text no. 2
    


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