Orbital Fracture

Aka: Orbital Fracture, Orbital Wall Fracture, Orbital Blow Out Fracture, Orbital Rim Fracture

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II. Pathophysiology

  1. Results from blunt Trauma to orbit
    1. Direct blow to orbital rim
    2. Blow to soft tissue within orbit, increasing pressures, with secondary blow-out Fracture
      1. Athletes account for one third of these injuries
  2. Most common injuries
    1. Orbital floor is most commonly affected

III. Symptoms

  1. Infraorbital nerve distribution decreased Sensation (orbital floor Fracture)
    1. Lower Eyelid
    2. Side of the nose
    3. Nasal septum (Cartilaginous segment)
    4. Anterior Maxilla
    5. Upper lip
  2. Eyelid swells after sneezing
    1. Communication between orbit and sinuses

IV. Signs

  1. Orbital rim tenderness to palpation
  2. Nasal complex flattening
  3. Traumatic Telecanthus (increased distance between medial canthus of each eye)

V. Exam: Red Flags

  1. Globe Rupture
  2. Facial Fracture
  3. Decreased Extraocular Movements (extraocular Muscle entrapment)
  4. Enophthalmos (posteriorly displaced eye)

VI. Imaging

  1. Orbital CT (with thin sections)

VII. Management

  1. Emergently consult Otolaryngology or Maxillofacial Surgery
  2. Ophthalmology Consultation if eye involvement
  3. Nasal Decongestants (e.g. Oxymetazoline, neosynephrine)
  4. Antibiotics if communication between orbit and sinuses
  5. Patient should not blow their nose, and try not to sneeze
  6. Surgery indications
    1. Extraocular Muscle entrapment with decreased Extraocular Movements
    2. Enophthalmos (posteriorly displaced eye)

VIII. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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