1 Assistant Professor of Pediatric Radiology, Johns Hopkins Hospital, Baltimore, Maryland 21205
The pediatrician often has the first opportunity to recognize the blowout type of injury of the orbit in children. Diagnosis of blowout fracture will depend upon a history of trauma to the eye with resultant diplopia, limitation in vertical gaze, possibly enophthalmus, and downward displacement of the affected eye. Sinus films and possibly tomograms will demonstrate one or both of the primary signs of blowout fracture of the orbit which include visualization of a depressed fragment of bone and herniation of orbital soft tissue into the maxillary sinus. Less reliable signs of blowout fracture are hemorrhagic opacification of the maxillary antrum, orbital emphysema, and haziness (blood) within the ethmoidal air cells. Surgical treatment is aimed at replacing herniated orbital contents and buttressing the orbital floor. Successful therapy for blowout fracture demands prompt recognition of the injury and early treatment to prevent atrophy of orbital contents.