Orbital blowout fracture due to true hydraulic pressure

In this report, we present an unusual case of an orbital floor fracture produced when a 56-year-old female was pushed in the face by the palm of her husband’s hand. After being pushed to the floor and held down with her face turned upwards, the woman’s husband applied pressure to her right eye region with his left palm. During this attack, she heard a cracking sound from her right orbital region, and felt dizziness, nausea, and diplopia immediately after the sound. CT scanning was undertaken, revealing a right orbital floor fracture which extended from the anterior portion of the floor to the orbital apex. A transmaxillary operation was undertaken 3 days after injury under general anesthesia. The herniated orbital tissue and fractured bone segments were reduced, and a maxillary balloon was inserted to sustain the reduced bone segments. The balloon was removed 5 weeks after the primary operation under local anesthesia. The patient’s right enophthalmos had cleared up, and CT scanning showed correct shape of the orbital floor 3 months after primary surgery. We conclude that this case of orbital floor fracture is the second reported case that supports a purely hydraulic theory.