White Eyed Blow out Fracture

“White-eyed blow out fracture (WEBOF)” is a term used for children who had periorbital trauma with mild signs of soft tissue damage. WEBOF can be easily missed, resulting in a lost opportunity for surgical intervention. A pediatric patient presented with vomiting and diplopia after sustaining trauma, she was referred to our institution 2 weeks after a suspected head injury. Examination showed marked limitation on upgaze and downgaze on the right eye with accompanying diplopia. CT scan of the orbits revealed a right orbital floor fracture, with herniation of orbital fat and a mildly thickened right inferior rectus muscle. Patient underwent repair of orbital floor fracture and release of muscle entrapment with silicone implant under general anesthesia. Although release of muscle entrapment and repair of floor fracture was achieved, EOM underaction on vertical gaze and diplopia persisted. Timely diagnosis and intervention of WEBOF is important, not only to reverse the oculocardiac reflex but also to minimize the possibility of permanent ischemic injury and contracture of the involved extraocular muscle, which could lead to long-term strabismus and diplopia. Because the first clinical presentation is similar to that of a head injury, it is often overlooked, resulting in a delay in diagnosis and permanent morbidity.