J Korean Ophthalmol Soc.  2015 Jun;56(6):961-966. 10.3341/jkos.2015.56.6.961.

A Case of Pediatric Medial-Orbital Wall Fracture with Extraocular Muscle Entrapment

• Jo SH
• Kim SJ

• KMID: 2339165
• DOI: http://doi.org/10.3341/jkos.2015.56.6.961

Abstract

PURPOSE
To report a case of pediatric medial wall blowout fracture with entrapment of medial rectus muscle which can be easily misdiagnosed as a cerebral lesion.
CASE SUMMARY
A 16-year-old male visited our clinic with headache, severe restriction of his right eye movement, and diplopia after a head injury due to falling occurring 1 day before evaluation. The patient was inebriated at the time of the accident and could not recall the event but occipital hematoma was palpable. Periorbital ecchymosis or edema was not observed with minimal soft tissue injury except mild conjunctival injection on slit-lamp examination. The patient had an 18 prism diopter exodeviation at primary position and severe medial and mild lateral gaze limitation in his right eye. Brain magnetic resonance imaging (MRI) showed no specific cerebral findings although trapdoor orbital medial wall fracture with incarceration of soft tissue and medial rectus muscle at the medial wall fracture site of his right eye was observed. Within 48 hours from the first evaluation, the blowout fracture was repaired and 50 days postoperatively, right eye gaze limitation and diplopia were nearly recovered.
CONCLUSIONS
A case of pediatric blowout fracture with uncertain injury location, periocular ecchymosis, or edema absent could be misdiagnosed as a cerebral lesion. If a pediatric patient is experiencing gaze limitation, diplopia, nausea, or vomiting after trauma, neurological examination as well as evaluation for blowout fracture should be performed.

Keyword

Entrapment of medial rectus muscle; Pediatric medial wall blowout fracture; White-eyed blowout fracture

MeSH Terms

Adolescent
Brain
Craniocerebral Trauma
Diplopia
Ecchymosis
Edema
Exotropia
Eye Movements
Headache
Hematoma
Humans
Magnetic Resonance Imaging
Male
Nausea
Neurologic Examination
Orbit
Soft Tissue Injuries
Vomiting

Figure

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  Figure 1. Preoperative photographs of 16-year-old patient show severe adduction and mild abduction limitation of his right eye. There was mild conjunctival injection and no soft-tissue ecchymosis or edema.

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  Figure 2. Magnetic resonance image showing fracture at right lamina papyracea with fat herniation and medial rectus muscle incarceration. No cerebral lesion was seen. (A) Axial and (B) coronal.

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  Figure 3. (A) Axial and (B) coronal computed tomography (CT) show an isolated small defect in the right medial wall with medial rectus muscle incarcerated within the fracture.

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  Figure 4. Postoperative eye motility at 50 days after repair surgery. Right eye gaze limitation was nearly recovered.

Reference

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