White-eyed blowout fracture: Diagnostic pitfalls and review of literature

White-eyed blowout fracture was first termed by Jordan et al. in individuals sustaining a blow to the periocular area and presenting with ocular symptoms, although with minimal soft tissue signs of trauma. It is often found in pure orbital floor blowout fractures among paediatric patients, and it could manifest as a linear or hinge-like trapdoor deformity. Unlike the more common open orbital blowout fractures with distinct diagnostic clinical signs, white-eyed blowout fractures are rarer and their diagnoses can be easily missed, subsequently costing an optimal time window for surgical intervention. This is critical as better outcomes are found with earlier release of entrapments. This report describes a case of a white-eyed blowout fracture in a 10-year-old child faced with its diagnostic challenges. The current literature review discusses the types of fracture pattern, signs and symptoms, mechanism of action, as well as timing of surgery. In view of the common complication of persistent diplopia, clinical pitfalls in achieving this diagnosis are emphasized to prevent any delay of treatment. Current literature evidences are weighted towards urgent surgical intervention, as positive outcomes are found to correlate with earlier release of entrapments.