Orbital fracture

Revision as of 23:16, 29 October 2010 by Robot (talk | contribs) (Created page with "Initial Assessment * Eye* Acuity, extraocular movements* Blurry, double, or decreased vision? * Pain with EOM? * Pupil* Reactivity, size, shape * Globe* Proptosis or enophtha...")
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

Initial Assessment

  • Eye* Acuity, extraocular movements* Blurry, double, or decreased vision?
  • Pain with EOM?


  • Pupil* Reactivity, size, shape
  • Globe* Proptosis or enophthalmos?
  • Increased intercanthal distance?
  • Extrusion of intraocular contents?
  • Orbit* 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:* Entrapment of inferior rectus
  • Enophthalmos
  • Damage to infraorbital nerve


  • Retinal Detachment
  • Hyphema
  • Optic Nerve Shealth Hematoma


Management


Orbital CT indicated for:

  • Evidence of fracture on exam
  • Decreased extraocular mobility
  • Decreased visual acuity
  • Severe pain
  • Unable to perform adequate exam


Globe Injury

  • Eye covering
  • Elevate head of bed
  • Prevent nausea/vomiting


Orbital Hematoma

  • Consider lateral canthotomy


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 fractures-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