title: The white-eyed medial blowout fracture.
abstract: BACKGROUND
  The pediatric white-eyed blowout fracture with entrapment of the inferior rectus muscle is well recognized as an easily missed injury with significant morbidity if left untreated. A series of five isolated medial orbital blowout fractures with medial rectus muscle entrapment is described. The purpose of this study was to define this injury pattern and its clinical outcome.
  
  
  METHODS
  A retrospective review of the presentation, management, and clinical outcomes of identified cases was conducted.
  
  
  RESULTS
  Early exploration and release of the entrapped muscle combined with implant reconstruction of the medial orbital wall within 2 weeks resulted in complete resolution of diplopia and full recovery of extraocular movements. Delayed treatment and release of the soft tissues without orbital wall reconstruction were associated with restricted gaze and diplopia. Similar outcomes were confirmed on analysis of other reported cases.
  
  
  CONCLUSIONS
  Orbital floor blowout fractures in the pediatric population have a high incidence of muscle entrapment that must be recognized and treated early to avoid muscle necrosis and permanent ocular restriction from fibrosis. Medial orbital wall fractures with entrapment are rare, but early recognition and operative release of the entrapped muscles result in better outcomes.
authors.affiliation: London, Ontario, Canada From the Division of Plastic and Reconstructive Surgery and Department of Ophthalmology, University of Western Ontario.
authors.forename: Raymond
authors.initials: R
authors.lastname: Tse
authors.forename: Lawrence
authors.initials: L
authors.lastname: Allen
authors.forename: Damir
authors.initials: D
authors.lastname: Matic
mesh_terms: D000293:Adolescent; D002648:Child; D005152:Facial Muscles / Q000293:injuries*; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery; D009917:Orbital Fractures / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies