Blowout Fracture: The Daily PANCE Blueprint

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Blowout Fracture: The Daily PANCE Blueprint

A 27-year-old male presents to the ER after being struck in the face with a baseball. He has peri-orbital swelling, pain, epistaxis, and difficulty moving his right eye upward. Physical exam reveals decreased sensation over the right cheek and upper lip. Visual acuity is reduced. Which of the following is the most appropriate next step in management?

A. MRI of the orbit
B. High-dose corticosteroids
C. Observation with outpatient follow-up
D. Plain radiographs of the facial bones
E. Immediate ophthalmologic consultation

Answer and topic summary

The answer is E. Immediate ophthalmologic consultation

Orbital floor fracture (blowout fracture) occurs when the orbital contents are traumatically forced through a fractured orbital floor. It usually occurs due to blunt trauma. Clinical features include proptosis, peri-orbital pain/edema, epistaxis, impairment of ocular movement, loss of sensation in the area (due to damage to the infraorbital nerve), and impaired visual acuity. CT head is the best diagnostic test. Management includes immediate ophthalmologic consultation.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint EENT ⇒ Disorders of the Eye ⇒ Traumatic disorders => Blowout fracture

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