Orbital fracture
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