Approach

Fractures of the orbit may be seen in different scenarios of direct and indirect trauma to the globe, and the orbital, facial, or cranial bones. The most common presentations of orbital fractures are associated with zygomatic complex fractures, and orbital 'blow-out' fractures of the floor/medial wall.[1] Peri-orbital and orbital blow-out fractures are more often complicated by ocular injuries compared with other facial fracture patterns.[17]

Blow-out fractures can be classified into:

  • Pure: fracture of the medial wall and orbital floor causes passing of the orbital soft tissues through the hole created, causing the globe level to drop (hypoglobus) and sink back (enophthalmos).

  • Impure: a direct blow to the inferior orbital rim causes a buckling of the orbital margin, and results in a blow-out pattern of fracture with a concomitant rim fracture.

Advanced trauma life support (ATLS) is the initial approach in the management of any patient who may have orbital fractures and accompanying systemic injuries. Once the patient has been stabilised, a careful assessment of the orbit injury should be performed.

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