'White-eyed' blowout fracture: a case series of five children

The 'white-eyed' blowout fracture is an orbital injury in children that is commonly initially misdiagnosed as a head injury because of predominant autonomic features and lack of soft-tissue signs. We present five patients who presented with nausea and vomiting following an apparent mild head or facial injury. None of the five had any external evidence of injury. Despite each case describing diplopia, there was a delayed diagnosis of at least 24 h. CT examination demonstrated an inferior orbital wall fracture in all cases with entrapment of the inferior rectus muscle. Each patient underwent surgical repair, two within 48 h of their injury, both of whom achieved complete recovery of ocular movements, while three were delayed beyond 48 h, with a resulting residual limitation of upgaze in all. It is, therefore, important for clinicians to be aware of this condition, so that it can be diagnosed early in order for early surgical release to be performed, which is associated with an excellent prognosis.