Blow-out fracture of the orbital floor.

Six patients with blowout fractures of the orbital floor, not associated with infraorbital rim fractures, are presented. Diplopia, infraorbital anesthesia and enophthalmos following blunt trauma to the eye should alert the examiner to the possibility of a blowout fracture with incarceration of extraocular tissues. Early roentgenographic examinations are often difficult to evaluate because of periorbital edema, mucosal swelling and antral hematoma. In cases in which stereoscopic Waters projections are equivocal, laminograms of the orbit, after the edema subsides, will aid in confirming the diagnosis. Forced ductions will often ascertain whether or not there is impingement of extraocular tissues in the fracture site. If there is no clinical evidence of incarceration or impingement of extraocular tissues, but only radiographic suggestion of a blowout fracture, there is a possibility that surgical intervention may be deferred and the patient carefully watched. However, early recognition and treatment of soft tissue incarcerations is necessary in order to avoid persistent diplopia, enopththalmos, and late cosmetic deformity.