Intervention within days for some orbital floor fractures: the white-eyed blowout

Management of blowout fractures involving the orbital floor has been controversial over the past several decades. One school of thought recommends conservative treatment for 4 to 6 months while another recommends a 'wait and watch' period of 2 weeks before intervention. The authors have encountered a group of patients with such fractures, commonly children (less than 16 years of age), who have sustained a blow to the periocular area, yet have marked motility restrictions in up and down gaze, minimal soft tissue signs of trauma, lack of enophthalmos, and very minimal evidence of floor disruption on radiologic exam. A 2-week waiting period has been found to be of little benefit in these persons and possibly harmful to their motility. We advocate surgery within the first few days after injury as it may help to avoid permanent motility restriction. The authors have termed this entity 'the white-eyed blowout fracture.'