Teardrop sign | Radiology Signs

Answer:

Teardrop sign represents a teardrop-shaped fragment of herniated intraorbital fat and/or inferior rectus muscle protruding through a fracture of the medial or inferior orbital floor, seen in orbital blowout or trapdoor fractures, often following blunt facial trauma; associated with entrapment leading to diplopia and restricted gaze, particularly in pediatric patients due to elastic bone. This orbital-floor CT sign is distinct from other unrelated “teardrop sign”/”teardrop fracture” terms used elsewhere in radiology (e.g., cervical spine teardrop fracture, aortic teardrop appearance).

Why is it called so?

Named for the characteristic teardrop-shaped appearance of the herniated orbital contents fragment suspended in the maxillary sinus through the orbital floor defect.

Pathophysiology

Blunt trauma causes increased intraorbital pressure, resulting in hydraulic blowout fracture of the thin medial/inferior orbital floor; orbital fat and inferior rectus muscle herniate into the maxillary sinus, forming a teardrop configuration due to gravity and soft tissue density contrast against aerated sinus.

Alternative names:
Hanging drop sign (used interchangeably for the same orbital floor herniation appearance)

Other associated named signs:
White-eyed blowout fracture (linear trapdoor fracture, typically in children/young adults, with significant muscle/fat entrapment despite deceptively minimal external periorbital signs)

References

1. Hakkou Z, et al. Pediatric trapdoor fracture of the orbital floor with Tear-Drop sign: A case report. Radiol Case Rep. 2025;20(3):1234-1238.
2. Ethunandan M, Evans BT. Linear trapdoor or “white-eye” blowout fracture of the orbit: not restricted to children. Br J Oral Maxillofac Surg. 2011;49(2):142-147.