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. Decreased Extraocular Movements
  2. Enophthalmos (posteriorly displaced eye)
  3. Orbital rim tenderness to palpation

V. Exam

  1. Evaluate for Globe Rupture
  2. Evaluate other facial bones for Fracture

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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Related Studies

Ontology: Orbital Fractures (C0029184)

Definition (MSH) Fractures of the bones in the orbit, which include parts of the frontal, ethmoidal, lacrimal, and sphenoid bones and the maxilla and zygoma.
Concepts Injury or Poisoning (T037)
MSH D009917
ICD10 S02.8
SnomedCT 95851007
English Fractures, Orbital, Orbital Fracture, Fracture, Orbital, Orbital Fractures, Orbital Fractures [Disease/Finding], of orbit fracture, bones fractures orbital, orbit fracture, orbital fracture, fractures orbit, fractures orbital, fracture orbit, fracture orbital, orbital bone fracture, orbital fractures, Fracture of orbit NOS, Fracture of orbital bones, Periorbital fracture, Fracture of orbit (diagnosis), fracture of skull - orbit, Fracture of orbit, Fracture of orbital fossa, Fracture of orbit (disorder), Orbital fracture, fracture; orbit, orbit; fracture, Fracture of orbit, NOS, Fracture of orbital bones, NOS, Orbital fracture, NOS
Dutch oogkasfractuur, fractuur; orbita, orbita; fractuur, Fracturen, orbita-, Fractuur, orbita-, Orbitafracturen, Orbitafractuur
French Fracture orbitale, Fractures orbitaires, Fractures de l'orbite
German Fraktur der Orbita, Orbitafrakturen
Italian Frattura orbitale, Fratture delle orbite
Portuguese Fractura orbitária, Fraturas Orbitárias
Spanish Fractura orbitaria, fractura de huesos orbitarios, fractura de los huesos orbitarios, fractura de órbita (trastorno), fractura de la órbita (trastorno), fractura de órbita, fractura de la órbita, fractura orbitaria, Fracturas Orbitales
Swedish Ögonhålefrakturer
Japanese ガンカコッセツ, 骨折-眼窩, 骨折-吹き抜け, 吹き抜け骨折, 眼窩吹き抜け骨折, 眼窩ふきぬけ骨折, ブローアウト骨折, 骨折-うち出し, 眼窩骨折, うち出し骨折
Finnish Silmäkuopan murtumat
Russian GLAZNITSY PERELOMY, ГЛАЗНИЦЫ ПЕРЕЛОМЫ
Czech Zlomenina orbity, orbita - fraktury, fraktury orbity, zlomeniny očnice, fraktury očnice, zlomeniny orbity
Polish Złamania oczodołu
Hungarian Orbita-törés
Norwegian Øyehulefrakturer, Øyehulebrudd, Orbitabrudd, Orbitafrakturer

Ontology: Blow out fracture of orbit (C0347775)

Concepts Injury or Poisoning (T037)
SnomedCT 157181006, 263167007
Dutch blow-out fractuur orbita
German Orbitabodenfraktur
Italian Frattura a scoppio dell'orbita
Portuguese Fractura da órbita por onda de choque
Spanish Fractura por estallido de la órbita, fractura por estallido de órbita, fractura por estallido de la órbita (trastorno), fractura por estallido de la órbita, fractura por estallido de órbita (trastorno)
Japanese 眼窩吹き抜け骨折, ガンカフキヌケコッセツ
French Fracture isolée du plancher de l'orbite
English Blow out fracture of orbit, orbital blow out fracture, orbital blow-out fracture, blow out fractures orbital, fracture of skull - orbit blow out, blow out fracture of orbit, blow out fracture of orbit (diagnosis), Blow out fracture of orbit (disorder), Blowout fracture of orbit
Czech Blow out zlomenina orbity
Hungarian Orbita-törés