Internal orbital fractures in the pediatric age group: characterization and management

Ophthalmology. 2000 May;107(5):829-36. doi: 10.1016/s0161-6420(00)00015-4.


Objective: To evaluate the specific characteristics and management of internal orbital fractures in the pediatric population.

Design: Retrospective observational case series.

Participants: Thirty-four pediatric patients between the ages of 1 and 18 years with internal orbital ("blowout") fractures.

Methods: Records of pediatric patients presenting with internal orbital fractures over a 5-year period were reviewed, including detailed preoperative and postoperative evaluations, surgical management, and medical management.

Main outcome measures: Ocular motility restriction, enophthalmos, nausea and vomiting, and postoperative complications.

Results: Floor fractures were by far the most common fracture type (71%). Eleven of 34 patients required surgical intervention for ocular motility restriction. Eight were trapdoor-type fractures with soft-tissue incarceration; five had nausea and vomiting. Early surgical intervention (<2 weeks) resulted in a more complete return of ocular motility compared with the late intervention group.

Conclusions: Trapdoor-type fractures, usually involving the orbital floor, are common in the pediatric age group. These fractures may be small with minimal soft-tissue incarceration, making the findings on computed tomography scans quite subtle at times. Marked motility restriction and nausea/vomiting should alert the physician to the possibility of a trapdoor-type fracture and the need for prompt surgical intervention.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Eye Injuries / diagnosis*
  • Eye Injuries / etiology
  • Eye Injuries / surgery*
  • Female
  • Humans
  • Infant
  • Male
  • Nausea / diagnosis
  • Nausea / etiology
  • Ocular Motility Disorders / diagnosis
  • Ocular Motility Disorders / etiology
  • Ocular Motility Disorders / surgery
  • Orbit / injuries*
  • Orbital Fractures / diagnosis*
  • Orbital Fractures / etiology
  • Orbital Fractures / surgery*
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Visual Acuity
  • Vomiting / diagnosis
  • Vomiting / etiology