Orbital Fractures

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Orbital fractures refer to fractures of the bony structure surrounding the eye. They often result from trauma and can affect the orbital rim, the orbital floor, or other parts of the orbit. These fractures can lead to complications affecting vision and eye movement.

Aetiology

Orbital fractures are typically caused by blunt trauma to the face, such as:

• Motor vehicle accidents
• Physical assaults
• Sports injuries
• Falls

Pathophysiology

The orbit consists of several bones that form a protective cavity for the eye. Trauma can cause these bones to fracture, potentially leading to displacement of the eye (enophthalmos), muscle entrapment, or injury to the optic nerve. Fractures can be classified into:

• Orbital rim fractures: Involving the outer edges of the orbit
• Blowout fractures: Involving the orbital floor or medial wall, often with herniation of orbital contents
• Combined fractures: Involving multiple parts of the orbital structure

Risk Factors

• Participation in contact sports
• Lack of protective eyewear during high-risk activities
• Involvement in motor vehicle collisions
• Occupational hazards (e.g., construction work)

Signs and Symptoms

Common signs and symptoms of orbital fractures include:

• Periorbital swelling and bruising
• Double vision (diplopia)
• Sunken appearance of the eye (enophthalmos)
• Restricted eye movement
• Decreased visual acuity
• Numbness in the area supplied by the infraorbital nerve
• Epistaxis (nosebleed)

Investigations

• Clinical history and physical examination
• Visual acuity testing
• Assessment of eye movement and pupillary reactions
• Palpation of the orbital rim to identify fractures
• Imaging studies:
  • CT scan of the orbit to assess the extent of the fracture and associated injuries
  • Plain radiographs if CT is not available

Management

Primary Care Management

• Immediate referral to an ophthalmologist or maxillofacial surgeon: For further evaluation and management
• Initial care:
  • Apply cold compresses to reduce swelling
  • Administer analgesics for pain relief
  • Advise the patient to avoid blowing their nose to prevent exacerbating the injury

Specialist Management

• Surgical intervention: Indicated for severe fractures, muscle entrapment, or significant enophthalmos. Procedures may include orbital floor repair or reconstruction.
• Observation: Minor fractures without significant displacement or functional impairment may be managed conservatively with regular follow-up.
• Regular follow-up to monitor healing and manage any complications

References

1. Patient.info. (2024). Zygomatic Arch and Orbital Fractures. Retrieved from Patient.info
2. NHS. (2023). Orbital Fractures. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Orbital Fractures: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Orbital Fractures. Retrieved from AAO

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