小结
定义
病史和体格检查
关键诊断因素
- diplopia on upward gaze
- derangement of globe position
- intercanthal distance increased
- oculovagal symptoms (bradycardia, hypotension, nausea/vomiting)
其他诊断因素
- visual disturbance
- periorbital ecchymosis
- periorbital edema
- nerve sensory loss
- subconjunctival hemorrhage
- step defect infraorbital rim
- loss of color vision
- impaired pupillary light reflex
- decreased visual acuity
危险因素
- direct trauma
- young adults and children
- older adults at risk of falls
- male sex
诊断性检查
首要检查
- x-ray of the face
- CT scan of the orbit
需考虑的检查
- MRI of the orbit
- forced duction test
- orthoptic test
新兴检查
- ultrasonographic orbital scanning
治疗流程
urgent eye morbidity
no urgent eye morbidity
撰稿人
作者
Alistair R.M. Cobb, MBBS, BDS, FRCS (OMFS), FDSRCS (Eng), MFSEM (UK)
Consultant Oral and Maxillofacial Surgeon
South West Cleft Service
United Hospitals Bristol NHS Trust
Bristol
UK
利益声明
ARMC is an author of a number of references cited in this topic.
鸣谢
Mr Alistair Cobb would like to gratefully acknowledge Mr Timothy Lloyd, a previous contributor to this topic.
利益声明
TL declares that he has no competing interests.
同行评议者
Andrew Parfitt, MBBS, FFAEM
Clinical Director
Acute Medicine
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident Emergency Medicine
St Thomas' Hospital
London
UK
利益声明
AP declares that he has no competing interests.
Mark I. Neuman, MD
Assistant Professor of Pediatrics
Children's Hospital Boston
Harvard Medical School
Boston
MA
利益声明
MIN declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Manolidis S, Weeks BH, Kirby M, et al. Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions. J Craniofac Surg. 2002 Nov;13(6):726-37. 摘要
Cobb A, Murthy R, Manisali M, et al. Oculovagal reflex in paediatric orbital floor fractures mimicking head injury. Emerg Med J. 2009 May;26(5):351-3. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- soft tissue trauma only
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