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J Craniofac Surg. 2011 Sep;22(5):1977-9. doi: 10.1097/SCS.0b013e31822eaa25.

White-eyed medial wall blowout fracture mimicking head injury due to persistent oculocardiac reflex.

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Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.


White-eyed medial wall blowout fracture associated with muscle entrapment is rare. It may present with symptoms consistent with an intracranial injury, delaying the diagnosis and putting the patient at risk for permanent damage. A case of an isolated white-eyed medial wall fracture associated with persistent bradycardia on abduction secondary to oculocardiac reflex as well as limited abduction mimicking sixth-nerve weakness is presented. Patients with white-eyed medial wall blowout fracture with muscle entrapment can present with oculocardiac reflex symptoms, pain, diplopia, and strabismus in the absence of any signs on ocular examination except for abnormal motility. Computed tomography imaging of the orbit should be performed to confirm the diagnosis, followed by immediate surgical intervention to avoid ischemia and permanent injury.

[Indexed for MEDLINE]

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