Orbital fracture

Initial Assessment

• Eye

1. Acuity, extraocular movements
2. Blurry, double, or decreased vision?
3. Pain with EOM?

• Pupil

1. Reactivity, size, shape

• Globe

1. Proptosis or enophthalmos?
2. Increased intercanthal distance?
3. Extrusion of intraocular contents?

• Orbit

1. Crepitus from fracture into sinuses?

DDX

• Orbital Hematoma
  • Proptosis, diffuse pain
• Ruptured Globe
  • Tear-shaped pupil
  • Extrusion of intraocular content
• Orbital zygomatic fracture
  • Most common
• Nasoethmoid fracture
  • Inspect for:
    • Damage to medial canthal ligament
    • Damage to lacrimal duct
    • Medial rectus entrapment
• Orbial Floor fracture
  • Inspect for:

1. Entrapment of inferior rectus
2. Enophthalmos
3. Damage to infraorbital nerve

• Retinal Detachment
• Hyphema
• Optic Nerve Shealth Hematoma

Treatment

• Orbital CT indicated for:

1. Evidence of fracture on exam
2. Decreased extraocular mobility
3. Decreased visual acuity
4. Severe pain
5. Unable to perform adequate exam

Orbital fracture into sinus

• Azithromycin or augmentin

Extraocular muscle entrapment

• May result in oculocardiac reflex -> vagal symptoms
  • Consider release of entrapped muscle

• Decreased extraocular movement not due to entrapment
  • Consider corticosteroids

Orbital blowout fx

• Water's view is 83% sensitive at detecting these. If present needs CT to eval soft tissue structures (retrobulbar hemmorhage). Surgical indications include greater tha 2mm enopthalmos and/or persistent diploplia.

10-20% have ocular injury. binocular diploplia from direct muscle injury resolves in 82%, but diploplia from entrapment requires surgical repair.Malignant emphysema and/or retrobulbar hemmorhage are emergencies requiring a lateral canthotomy.

See Also

Trauma: Maxilofacial