Oculovagal reflex in paediatric orbital floor fractures mimicking head injury

Area of Science:

• Ophthalmology
• Pediatric Surgery
• Trauma Surgery

Background:

• Orbital blowout fractures present uniquely in children, differing from adult presentations.
• Classic pediatric signs include white eye injury, upgaze diplopia, and malaise, often without subconjunctival hemorrhage.
• Oculovagal reflex can be triggered by globe pressure, a factor in ophthalmic and orbital trauma.

Purpose of the Study:

• To audit pediatric and young adult cases requiring surgical intervention for orbital blowout fractures.
• To highlight diagnostic and management challenges in pediatric orbital trauma.

Main Methods:

• Retrospective audit of patients referred to an Orbital Service.
• Inclusion of pediatric and young adult patients who underwent surgical repair.

Main Results:

• A significant proportion (one-third) of pediatric patients with orbital blowout fractures are admitted for head injury observation.
• The actual cause of symptoms in these children is frequently misdiagnosed or overlooked.
• Delayed recognition impacts the appropriate and timely management of orbital fractures.

Conclusions:

• Pediatric orbital blowout fractures necessitate prompt surgical intervention to prevent complications.
• Early surgical treatment is vital to avoid muscle ischemia and irreversible vision damage.
• Head injury observation protocols can delay necessary surgical treatment, potentially compromising outcomes.