Orbital roof fractures: different presentations in the ophthalmology emergency service, a case series

Abstract Orbital roof fractures typically present in context of head injury and rarely present at the ophthalmology emergency department. We present 3 cases triaged to ophthalmology with orbital roof fractures as the primary pathology. First case is a 3-month-old boy with conjunctival chemosis, lid edema and dystopia 5 days after falling from couch. Initial CT scan revealed orbital subperiosteal collection and patient was cleared by neurosurgery. Drainage done by ophthalmology revealed CSF leak. CT scan was repeated showed hairline skull base fracture through which CSF accumulated in the subperiosteal space. Leak was managed medically and stopped spontaneously. Second case is a 7-year-old boy referred to ophthalmology for evaluation of rupture globe and lid wound. Upon evaluation, brain tissue was found in orbit. CT scan revealed large roof fracture with brain herniation. Patient was referred to neurosurgery for further management. Lid wound repair was done at a later stage after patient stabilization. Third case is an 8-year-old boy with an acute inner canthal swelling clinically diagnosed as acute dacryocystitis. He had major trauma at the age of four with multiple facial fractures. Recent MRI revealed orbital encephalocele herniating through old roof fracture. DCR was performed with neurosurgery present as an extra precaution in case of encephalocele injury.