Pediatric orbital floor fractures: Nausea/vomiting as signs of entrapment

OBJECTIVE., We sought to explore whether nausea and vomiting are predictive of entrapment. STUDY DESIGN AND SETTING: We retrospectively evaluated the data regarding orbital floor fractures in children younger than 19 years old presenting at a tertiary care center from 1990 to 2001. Zygomatic, naso-orbital ethmoid, and displaced orbital rim fractures were excluded from our analysis. Data on the fracture type, signs and symptoms, ocular mobility, surgical repair, and resolution of diplopia were also collected. RESULTS., Twenty-nine orbital floor fractures were identified. One fourth of the children had nausea/vomiting, and half had trapdoor fractures. Seventeen percent of patients had entrapment of the inferior rectus. The positive predictive value of nausea/vomiting with a trapdoor fracture for entrapment was 83.3% (P = 0.002, Fisher exact test). Half the patients required surgical intervention, most commonly for diplopia or gaze restriction. Gaze impairment did not resolve in 2 patients. CONCLUSION. Patients with trapdoor fractures who present with nausea/vomiting are at a high risk of inferior rectus entrapment and poor outcome.