The “tear drop sign” is a specific finding in medical imaging that indicates underlying conditions, often related to trauma, and alerts medical professionals to potential issues within body structures. Its presence guides further investigation, helping to pinpoint the exact nature of an injury or abnormality.
Understanding the Tear Drop Sign
The tear drop sign typically appears as a polypoid soft tissue opacity, resembling a hanging “tear drop” or “glove finger” shape. It is observed in medical imaging of the orbit, the bony socket containing the eye. It is commonly identified on X-rays or Computed Tomography (CT) scans.
The formation of this sign results from the herniation of orbital contents into an adjacent space. Specifically, periorbital fat and sometimes the inferior rectus muscle drop through a defect in the orbital floor. This displacement creates the “tear drop” appearance as these tissues bulge into the maxillary sinus.
Primary Causes of the Tear Drop Sign
The main cause of the tear drop sign is an orbital blow-out fracture. This type of fracture occurs when a blunt object, often larger than the eye socket itself, strikes the eye. The impact causes a sudden increase in intraorbital pressure, causing the thin bone of the orbital floor to break.
The orbital floor is more prone to collapse because it lacks support. When this fracture occurs, orbital contents, such as fat and the inferior rectus muscle, can herniate into the maxillary sinus, creating the tear drop appearance. This is often observed in cases of direct trauma, such as a punch. While orbital blow-out fractures are the overwhelmingly common cause, other less frequent possibilities include certain tumors or mucoceles.
Diagnosis and Clinical Evaluation
The tear drop sign is primarily a radiological finding. While plain X-rays could sometimes reveal this sign, their sensitivity for detecting orbital fractures is limited. Computed Tomography (CT) scans are the standard for visualizing orbital fractures and the tear drop sign.
CT scans provide detailed cross-sectional images, allowing precise identification of the fracture and herniated orbital contents. Clinical symptoms often prompt imaging, including double vision (diplopia), especially when looking upwards, or a sunken appearance of the eye (enophthalmos). Restricted eye movement, pain with eye movement, and numbness in the cheek or upper lip due to nerve injury are common indicators that may lead to a CT scan.
Management and Prognosis
Management of conditions associated with the tear drop sign depends on the severity of symptoms and the fracture’s extent. For smaller, less symptomatic fractures, conservative management may involve observation, pain control, and application of ice packs. Patients are advised to avoid strenuous activity and nose blowing to prevent complications.
Surgical intervention is considered for larger fractures, those involving more than 50% of the orbital floor, or when significant functional impairment occurs. Indications for surgery include persistent or severe double vision, significant enophthalmos (sunken eye), or entrapment of extraocular muscles. Timely surgical repair, often within two weeks to allow swelling to subside, leads to good outcomes, with resolution of diplopia and correction of enophthalmos. While complications are possible, the prognosis for treated orbital blow-out fractures is favorable.