Management of orbital blow-out fractures. Case reports and discussion

Blow-out fractures are fractures of the orbital floor or medial wall that occur as a consequence of blunt trauma. Impact increases the intraorbital pressure, forcing the nondistensible orbital contents through the orbital floor. The fracture is commonly caused by impact from a baseball or tennis ball. However, any blunt trauma to the orbit, as from a knee or elbow, can result in a blow-out fracture. The characteristic clinical findings include double vision, a sunken globe, and numbness in the distribution of the infraorbital nerve. Sometimes, the only sign of a blow-out fracture is the abrupt inflation of periorbital tissue with air when the patient blows his nose. Standard evaluation of these fractures includes history, physical examination, and radiographs. Some patients benefit from computed tomography (CT), which can be both diagnostic and prognostic. Blow-out fractures do not often produce serious sequelae, and the current trend is toward no treatment. However, it is imperative to rule out any serious injury to the eye itself that would require emergency treatment.