Summary
Definition
History and exam
Key diagnostic factors
- diplopia ao olhar para cima
- alteração da posição do globo
- distância intercantal aumentada
- sintomas oculovagais (bradicardia, hipotensão, náuseas/vômitos)
Other diagnostic factors
- distúrbio visual
- equimose periorbital
- edema periorbital
- perda da sensibilidade do nervo
- hemorragia subconjuntival
- defeito de alinhamento da borda infraorbital
- perda da visão das cores
- reflexo pupilar à luz alterado
- acuidade visual reduzida
Risk factors
- trauma direto
- adultos jovens e crianças
- idosos em risco de quedas
- sexo masculino
Diagnostic investigations
1st investigations to order
- radiografia da face
- tomografia computadorizada (TC) da órbita
Investigations to consider
- ressonância nuclear magnética (RNM) da órbita
- teste de ducção forçada
- teste ortóptico
Emerging tests
- exame ultrassonográfico orbital
Treatment algorithm
morbidade ocular urgente
sem morbidade ocular urgente
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.
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.
References
Key articles
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. Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- apenas trauma dos tecidos moles
More DifferentialsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer