[GODREKR]

A 7-year-old presented to the emergency department (ED) with complaints of right eye pain and double vision. The patient had been involved in a sledding accident 1 week before, in which he crashed into a fence. There was no loss of consciousness. On examination in the ED, the right eye was proptotic and dystopic (Figure 1), although with normal visual acuity and no deficits during visual field testing. The pupils were equal, round, and reactive to light, without evidence of an afferent pupillary defect. Dilated funduscopic examination was normal. Extraocular mobility demonstrated limitation of upward gaze and adduction of the right eye. Computed tomographic imaging of the head including facial cuts was performed (Figure 2, Figure 3).

Patient with proptosis and orbital dystopia, with the right eye lower than the left. There is also limitation of upward gaze.


Coronal computed tomographic image.


Sagittal computed tomographic image.

Diagnosis

Superior orbital wall fracture with retro-orbital hematoma.
Limitation of upward gaze in the setting of trauma is most commonly associated with a fracture of the floor of the orbit, typically referred to as “blowout fracture.” Entrapment of the inferior rectus muscle within the orbital floor may lead to ophthalmoplegia and diplopia. In such cases, posterior displacement of the globe and prolapse of orbital contents into the maxillary sinus more commonly leads to enophthalmos (recession of the globe into the orbit), as opposed to proptosis.

This patient had limitation of upward gaze, with proptosis and orbital dystopia with the right eye lower than the left (Figure 1). Here, limitation of upward gaze was due to a mass lesion (retro-orbital hematoma) impinging on the globe (Figure 2), rather than extraocular muscle dysfunction. Orbital roof fractures are rare, although they are more common in young children because of their high cranium-to-midface ratio. Such fractures have a high association with intracranial injury, most commonly epidural hematoma, as was seen in our patient (Figure 3).

[30564U]

Was that the before photo? The kid looks fine to me.

[divreaper]

Captain cod eye....na serious hope he's alright

[vagabond]

Jeeze- he was like that for a week?

[kellyhound]

don't give me the eye will you ?

[corpsehands]

Googly eyes

[LadyCPlum]

I feel like I'm getting the stank eye

[30564U]

What you talk'n bout Willis?

[LadyCPlum]

Originally Posted by 30564U ↗

What you talk'n bout Willis?

Mother of Fuck that's hilarious

[Kelseecat65]

His left eye looks wonky too...it's making me dizzy to look at him!