Traumatic Orbital Floor Fracture Causing Therapeutic Orbital Decompression in Thyroid Eye Disease

This is a case of a 67-year-old female with a history of Graves’ disease and associated thyroid eye disease who presented to the emergency room after falling and hitting her head. Subsequently, she noted periorbital air on the left side when blowing her nose. A CT scan in the emergency room revealed a left orbital floor fracture and decompression of the left orbit. While nonsurgical orbital decompression in the setting of Graves’ eye disease has been reported in several instances, spontaneous ethmoid bone remodeling or fracture has been the most cited mechanism, with rarer instances of true spontaneous orbital floor fracture. Furthermore, there exist only two known case reports of traumatic orbital floor fractures with subsequent orbital decompression in the setting of thyroid eye disease. In only one of the two known cases, therapeutic effect was established. However, no significant follow-up period was noted. This case represents a rare traumatic orbital floor fracture resulting in orbital decompression with demonstrably improved exophthalmos. It is the first to include definitive follow-up both before and after operative management of the contralateral orbit.