Orbital fractures
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Orbital fractures refer to fractures of the bony orbit surrounding the eye, most commonly involving the orbital floor (blowout fractures) or medial wall.
Aetiology
- Blunt trauma: direct impact from fists, sports injuries, or road traffic accidents.
- Penetrating trauma: sharp object injuries or high-velocity projectiles.
- Falls: common in elderly patients.
Pathophysiology
- Sudden increase in intraorbital pressure causes fractures, often involving the thin orbital floor or medial wall.
- Entrapment of orbital contents (e.g., extraocular muscles, fat) may lead to motility restriction and diplopia.
- Orbital haematoma or emphysema can further compromise vision and eye movement.
Risk Factors
- Participation in contact sports.
- Facial trauma from road traffic accidents.
- Osteoporosis or other bone-weakening conditions.
- History of previous orbital injury.
Signs and Symptoms
- Periorbital swelling and ecchymosis: common after trauma.
- Diplopia: due to muscle entrapment.
- Restricted eye movement: especially in upward gaze with inferior rectus entrapment.
- Enophthalmos: posterior displacement of the eye.
- Infraorbital numbness: if the infraorbital nerve is affected.
Investigations
- CT scan of the orbits: gold standard for diagnosing fractures and assessing soft tissue involvement.
- Ophthalmic examination: evaluates visual acuity and extraocular movements.
- Slit-lamp examination: assesses corneal injury or globe rupture.
Management
1. Conservative Management:
- Cold compresses: reduce swelling in the acute phase.
- Analgesia: paracetamol or NSAIDs for pain relief.
- Antibiotic prophylaxis: for fractures involving the sinuses (e.g., amoxicillin).
- Avoidance of nose-blowing: prevents orbital emphysema.
2. Surgical Management:
- Orbital fracture repair: indicated if there is significant enophthalmos, persistent diplopia, or muscle entrapment.
- Canthotomy and cantholysis: if orbital compartment syndrome is present.
3. Referral:
- Ophthalmology: for all suspected orbital fractures.
- Maxillofacial surgery: if surgical intervention is required.
- Neurosurgery: if associated with significant cranial trauma.