Orbital fractures

Orbital fractures are traumatic injuries usually caused by assault, sports, or accidents.

A careful evaluation of the orbit injury may include examination of the facial bones, eyelids, and surrounding soft tissue; inspection of the globe; and visual acuity.

A definitive diagnosis is confirmed by computed tomography scan of the orbit.

Urgent surgery is indicated in pediatric patients with signs of soft tissue (muscle) entrapment; namely upgaze limitation and the oculovagal response (presence of vagal stimulation by pressure to intraorbital structures, which results in bradycardia, hypotension, and nausea and/or vomiting). Surgery is delayed in most adult cases to allow edema and hemorrhage to resolve. In small, non-blowout fractures, conservative treatment may be considered.

The use of goggles or safety glasses in contact sports is recommended to prevent orbital fractures and associated injuries.

The orbit is one of a pair of bony cavities each housing the globe and associated structures. The orbit is formed by 7 bones: zygomatic, sphenoid, maxillary, frontal, lacrimal, palatine, and ethmoid.

Fractures of the orbit may be seen in different scenarios of direct and indirect trauma to the globe, orbital, facial, or cranial bones. The most common presentation of orbital fractures is associated with zygomatic complex fractures (i.e., involving the cheek bone and thus the lateral orbital wall). The most common intraorbital fracture is the medial wall "blowout" fracture.[1]al-Qurainy IA, Stassen LF, Dutton GN, et al. The characteristics of midfacial fractures and the association with ocular injury: a prospective study. Br J Oral Maxillofac Surg. 1991 Jan;29(1):291-301. http://www.ncbi.nlm.nih.gov/pubmed/1742258?tool=bestpractice.com