Tear drop sign is seen in

FRACTURES OF ORBITAL FLOOR Zygomatic and Le Fo II maxillary fractures are always accompanied by fractures of orbital floor. Isolated fractures of orbital floor, when a large blunt object strikes the globes, are called "blow out fractures." Orbital contents may herniate into the antrum. CLINICAL FEATURES 1. Ecchymosis of lid, conjunctiva and sclera. 2. Enophthalmos with inferior displacement of the eyeball. This becomes apparent when oedema subsides. 3. Diplopia, which may be due to displacement of the eyeball or entrapment of inferior rectus and inferior oblique muscles. 4. Hypoaesthesia or anaesthesia of cheek and upper lip, if infraorbital nerve is involved. DIAGNOSIS Waters' view shows a convex opacity bulging into the antrum from above (tear-drop opacity). CT scans may confirm the Diagnosis. Entrapment of inferior rectus and inferior oblique muscles is diagnosed by asking the patient to look up and down, or by the traction test. The latter is performed by grasping the globe and passively rotating it to check for restriction of its movements. TREATMENT Indications for surgery include enophthalmos and persistent diplopia due to entrapment of muscle. Orbital floor fractures can be satisfactorily reduced by a finger passed into the antrum through a transantral approach. A pack can be kept in the antrum to suppo the fragments. Infraorbital approach, through a skin crease of the lower lid, can also be used either alone or in combination with transantral approach. Badly comminuted fractures of orbital floor can be repaired by a bone graft from the iliac crest, nasal septum or the anterior wall of the antrum. Silicon or teflon sheets have also been used to reconstruct the orbital floor but autogenous grafts are preferable. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 184