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Orbital fractures

Last reviewed: 14 Oct 2024
Last updated: 20 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • diplopia on upward gaze
  • derangement of globe position
  • intercanthal distance increased
  • oculovagal symptoms (bradycardia, hypotension, nausea/vomiting)
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

  • young adults and children
  • male sex
Full details

Diagnostic tests

1st tests to order

  • x-ray of the face
  • CT scan of the orbit
Full details

Tests to consider

  • MRI of the orbit
  • forced duction test
  • orthoptic test
Full details

Emerging tests

  • ultrasonographic orbital scanning

Treatment algorithm

ACUTE

urgent eye morbidity

no urgent eye morbidity

Contributors

Authors

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

Disclosures

ARMC is an author of a number of references cited in this topic.

Acknowledgements

Mr Alistair Cobb would like to gratefully acknowledge Mr Timothy Lloyd, a previous contributor to this topic.

Disclosures

TL declares that he has no competing interests.

Peer reviewers

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

Disclosures

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

Disclosures

MIN declares that he has no competing interests.

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