Linear trapdoor or “white-eye” blowout fracture of the orbit: not restricted to children

The management of orbital blowout fractures remains controversial, particularly in patients with a white-eye or trapdoor-type injury. We report our experience with 10 such cases (mean age 19.6 years, range 4–53) and show, unlike previous reports, that this pattern of injury is not restricted to children. Although most patients had a white eye (70%), the presence of subconjunctival haemorrhage and periorbital bruising did not exclude this injury, and the patients often (60%) had serious autonomic symptoms such as nausea and vomiting. A high index of suspicion and cross-sectional imaging is required to confirm the diagnosis. Early intervention (less than 7 days) seems to be associated with better outcome, but patients benefitted from intervention up to 41 days after injury. The mechanism underlying this pattern of injury and the rationale behind early intervention is also discussed.