[Blunt trauma to the eye in children: more than a black eye]

The consequences of orbital floor fractures are different in children than in adults. Children have more elastic bones and increased chance of a trapdoor fracture, a fracture in which muscle tissue may be trapped.

A 12-year-old girl presented to the general practitioner after she had been hit in her left eye by a swing. The patient had a painful eye and double vision. She was sent home with the advice to wake her every hour during the night. The next morning she went back to the general practitioner because she had been vomiting through the night and this time she was sent to the hospital. She was diagnosed with an orbital floor fracture with an entrapment of the inferior rectus muscle and underwent immediate surgery. Unfortunately, the release of the muscle had been too late and resulted in an uncorrectable diplopia.

Warning signs of entrapment of the inferior rectus muscle are a painful eye with a mobility disorder in combination with nausea and vomiting. Immediate surgical intervention offers the best outcome in terms of recovery of the eye motility.