Orbital fracture

Initial Assessment

1. Eye
   1. Acuity, extraocular movements
   2. Blurry, double, or decreased vision?
   3. Pain with EOM?
2. Pupil
   1. Reactivity, size, shape
3. Globe
   1. Proptosis or enophthalmos?
   2. Increased intercanthal distance?
   3. Extrusion of intraocular contents?
4. Orbit
   1. Crepitus from fracture into sinuses?

DDX

1. Orbital Hematoma
   1. Proptosis, diffuse pain
2. Ruptured Globe
   1. Tear-shaped pupil
   2. Extrusion of intraocular content
3. Orbital zygomatic fracture
   1. Most common
4. Nasoethmoid fracture
   1. Inspect for:
      1. Damage to medial canthal ligament
      2. Damage to lacrimal duct
      3. Medial rectus entrapment
5. Orbial Floor fracture
   1. Inspect for:
      1. Entrapment of inferior rectus
      2. Enophthalmos
      3. Damage to infraorbital nerve
6. Retinal Detachment

• Hyphema
• Optic Nerve Shealth Hematoma

Treatment

Orbital CT indicated for

1. Evidence of fracture on exam
2. Decreased extraocular mobility
3. Decreased visual acuity
4. Severe pain
5. Unable to perform adequate exam

Globe Injury

• Eye covering
• Elevate head of bed
• Prevent nausea/vomiting

Orbital Hematoma

• Consider lateral canthotomy

Orbital fracture into sinus

• Azithromycin or augmentin

Extraocular muscle entrapment

• May result in oculocardiac reflex -> vagal symptoms* Consider release of entrapped muscle

Decreased extraocular movement not due to entrapment

• Consider corticosteroids

Orbital blowout fractures-Water's view is 83% sensitive at detecting these. If present needs CT to eval soft tissue structures (retrobulbar hemmorhage). Surgical indications include greater tha 2mm enopthalmos and/or persistent diploplia.

10-20% have ocular injury. binocular diploplia from direct muscle injury resolves in 82%, but diploplia from entrapment requires surgical repair.Malignant emphysema and/or retrobulbar hemmorhage are emergencies requiring a lateral canthotomy.

See Also

Trauma: Maxilofacial