Blowout fracture of the orbit. Diagnosis and treatment.

One of the earliest descriptions of what is now referred to as blowout fracture of the orbit was reported by Lang (I889). The mechanism involved in this type of fracture was first suggested by Pfeiffer (I943) and later defined and proven by Converse (i962), Converse and Smith (I957, I959, 1960), and Smith and Converse (I957). A true blowout fracture of the orbit can occur as a specific syndrome without any other associated facial fractures (the so-called pure blowout fracture) or it can be found in association with multiple facial injuries as is frequently the case in automobile accidents. In general, the ophthalmologist is well equipped to diagnose and treat the pure blowout fracture, but the latter situation usually requires the services of a maxilliary-facial con-sultant to handle the associated facial injuries. This discussion will deal only with the pure blowout fracture of the orbit. An examination of the bony orbit quickly reveals two areas of weakness; the orbital plate of the ethmoid bone which overlies the ethmoid sinuses and the orbital floor lying over the maxillary sinus (Fig. i). A blowout fracture usually occurs when a sudden blow to the eye pushes the intact globe back into the orbit. There is an associated momentary