Orbital Fracture

Orbital Fracture


Diplopia field: limit on up or downgaze: r/o IR entrapment vs hemorrhage/edema alone: CTEvaluation - Full Ophthalmic Exam Plus

Evaluation - Full Ophthalmic Exam Plus Evaluation - Full Ophthalmic Exam Plus
Evaluation - Full Ophthalmic Exam Plus

Mechanism


The rates of injury were also compared between pure orbital floor fractures (only floor) and impure (floor and rim). Of patients who sustained a pure orbital floor fracture, intraocular injuries occurred in 5.6%, compared with only 2% that sustained an impure fracture. Intraocular injuries are more common in patients who sustained PURE orbital fractures than in patients with rim involvement (IMPURE) (p=0.05). This difference suggests that the mechanism of injury might possibly not be the same in each; it might possibly not simply be solely direct force transmitted to the rim as the buckling theory suggests.Intraocular Injuries

 

 

Buckling:

Retropulsion

 

Globe to Wall:

 

Consequences of trauma

Double Vision

Illustrations of relevant orbital anatomy

 

 

 

 

Surgery Indications

Surgery Indications

  • residual marked diplopia w/in 30of 1o gaze 2o to restriction (of IR)

  • large (50%) floor fracture especially with large med wall fracture because likely to get enophthalmos

  • enophthalmos > 2 mm: usually there is initial proptosis 2o to orb infl/edema which resolves; if initial enophthalmos or no prop, later surgery for enophthalmos more likely

 

  • surgical repair easier within the initially 2 weeks

  • surgical steps: usually inferior fornix incision, elevate periorbita from orb floor, free tissues from fracture, implant (silastic or miniplate depending on size) over floor defect

Surgery Indications

 

Medial Orbital Fracture

Zygomatic Fracture

Orbital Apex Fracture

Orbital Roof Fracture

Orbital Emphysema

Treatment

early surgery for marked muscle restriction confirmed on CT, forced duction

 

should observe 1-2 weeks, oral steroids (prednisone 1 mg/kg/day with taper) to decrease swelling and fibrosis

 

antibiotics (Keflex) and nasal decongestants (Afrin), tell patient not to blow nose to decrease orbital emphysema