BLOW-OUT  FX

 

S & S:

  1. Fx of orbital floor or medial wall of orbit.
     
  2. Associated injuries are ethmoid fx and, obviously, the eye.
     
  3. Other injuries are to External Ocular Muscle/Nerve with deficit to ocular movement mainly on upward gaze 2ry to inferior rectus entrapment, diplopia, numbness to infraorbital area due to injury to the infraorbital nerve, enophtalmus due to herniation of periorbital fat.

DX:

  1. See in "overview". Do CT with coronal and axial cuts - it may detect retrorbital hematoma.

Treatment:

  1. Treatment of the eye must be addressed first. Swelling may interfere, thus exam must be done  ASAP.
     
  2. If  the eye and C-III not affected, and only x-ray finding is blood in maxillary sinus (AF level), patient is DC with antbx.
     
  3. Patient is advised not to blow nose for few days. This will cause sq emphysema in case there is a  communication between ethmoid and medial wall of orbit. Patient is given decongestants and laxatives.

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