Orbital fracture: Difference between revisions
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==Background== | ==Background== | ||
* | *Types | ||
* | **Blow-out Fracture | ||
* | ***Fracture of inferior or medial orbital walls w/o fx of orbital ridge | ||
***Adipose tissue, inf rectus or inf oblique can entrap w/in maxillary or ethmoid sinus | |||
**Non blow-out fx | |||
***Lateral, inf, and sup orbital ridge fx typically occur w/ other facial fractures | |||
*Naso-orbito-ethmoid fx | |||
**A/w force applied to nasal bridge | |||
**Often accompanied by injury to lacrimal duct, dural tears, and TBI | |||
==Diagnosis== | ==Diagnosis== | ||
*Findings suggestive of orbital fx: | |||
**Enophthalmos (globe herniation) | |||
**Orbital rim step-off | |||
**Crepitus | |||
**Infraorbital anesthesia (orbital floor fx) | |||
**Diplopia on upward gaze | |||
***Entrapment of inf rectus or inf oblique or orbital fat | |||
***Injury to oculomotor nerve | |||
*Findings suggestive of naso-orbito-ethmoid fx | |||
**Pain w/ eye movement | |||
**Traumatic telecanthus | |||
**Epiphora (tears spilling over lower lid) | |||
**CSF leak | |||
*Findings suggestive of ocular involvement: | |||
**Retrobulbar hematoma or malignant orbital emphysema | |||
***Exophthalmos, decreasing visual acuity, increased ocular pressure | |||
**Orbital fissure syndrome | |||
***Fx of orbit involving the sup. orbital fissure | |||
****May result in injury to oculomotor and ophthalmic divisions of CN V | |||
****Paralysis of extraocular motions, ptosis, periorbital anesthesia | |||
=== | ==Imaging== | ||
*Obtain orbital CT as initial study in pts w/ sig clinical findings | |||
**Evidence of fracture on exam | |||
**Decreased extraocular mobility | |||
**Decreased visual acuity | |||
**Severe pain | |||
**Unable to perform adequate exam | |||
*Otherwise can obtain Waters' view first | |||
==Management== | |||
*Isolated orbital fx | |||
**D/c home w/ amoxicillin-clavulanate, decongestants, instructions to avoid nose blowing | |||
**Obtain f/u within 1-2wk for adults, shorter period for children | |||
*Naso-orbito-ethmoid fx | |||
**Admit | |||
*Ocular injury | |||
**Emergent ophtho consultation | |||
*Malignant emphysema and/or retrobulbar hemmorhage | |||
**Lateral canthotomy | |||
*Extraocular Muscle Dysfunction | |||
**May result in oculocardiac reflex -> vagal symptoms | |||
**Consider release of entrapped muscle | |||
*Decreased extraocular movement not due to entrapment | |||
**Consider corticosteroids | |||
**Surgical indications include greater tha 2mm enopthalmos and/or persistent diploplia | |||
==DDX== | ==DDX== | ||
#[[Orbital Hematoma]] | #[[Orbital Hematoma]] | ||
##Proptosis, diffuse pain | ##Proptosis, diffuse pain | ||
#[[ | #[[Globe Rupture]] | ||
##Tear-shaped pupil | ##Tear-shaped pupil | ||
##Extrusion of intraocular content | ##Extrusion of intraocular content | ||
| Line 43: | Line 76: | ||
#Retinal Detachment | #Retinal Detachment | ||
##Hyphema | ##Hyphema | ||
##Optic Nerve | ##Optic Nerve Sheath Hematoma | ||
==See Also== | ==See Also== | ||
*[[Orbital Hematoma]] | *[[Orbital Hematoma]] | ||
*[[ | *[[Globe Rupture]] | ||
==Source== | |||
Tintinalli's | |||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 21:23, 16 July 2011
Background
- Types
- Blow-out Fracture
- Fracture of inferior or medial orbital walls w/o fx of orbital ridge
- Adipose tissue, inf rectus or inf oblique can entrap w/in maxillary or ethmoid sinus
- Non blow-out fx
- Lateral, inf, and sup orbital ridge fx typically occur w/ other facial fractures
- Blow-out Fracture
- Naso-orbito-ethmoid fx
- A/w force applied to nasal bridge
- Often accompanied by injury to lacrimal duct, dural tears, and TBI
Diagnosis
- Findings suggestive of orbital fx:
- Enophthalmos (globe herniation)
- Orbital rim step-off
- Crepitus
- Infraorbital anesthesia (orbital floor fx)
- Diplopia on upward gaze
- Entrapment of inf rectus or inf oblique or orbital fat
- Injury to oculomotor nerve
- Findings suggestive of naso-orbito-ethmoid fx
- Pain w/ eye movement
- Traumatic telecanthus
- Epiphora (tears spilling over lower lid)
- CSF leak
- Findings suggestive of ocular involvement:
- Retrobulbar hematoma or malignant orbital emphysema
- Exophthalmos, decreasing visual acuity, increased ocular pressure
- Orbital fissure syndrome
- Fx of orbit involving the sup. orbital fissure
- May result in injury to oculomotor and ophthalmic divisions of CN V
- Paralysis of extraocular motions, ptosis, periorbital anesthesia
- Fx of orbit involving the sup. orbital fissure
- Retrobulbar hematoma or malignant orbital emphysema
Imaging
- Obtain orbital CT as initial study in pts w/ sig clinical findings
- Evidence of fracture on exam
- Decreased extraocular mobility
- Decreased visual acuity
- Severe pain
- Unable to perform adequate exam
- Otherwise can obtain Waters' view first
Management
- Isolated orbital fx
- D/c home w/ amoxicillin-clavulanate, decongestants, instructions to avoid nose blowing
- Obtain f/u within 1-2wk for adults, shorter period for children
- Naso-orbito-ethmoid fx
- Admit
- Ocular injury
- Emergent ophtho consultation
- Malignant emphysema and/or retrobulbar hemmorhage
- Lateral canthotomy
- Extraocular Muscle Dysfunction
- May result in oculocardiac reflex -> vagal symptoms
- Consider release of entrapped muscle
- Decreased extraocular movement not due to entrapment
- Consider corticosteroids
- Surgical indications include greater tha 2mm enopthalmos and/or persistent diploplia
DDX
- Orbital Hematoma
- Proptosis, diffuse pain
- Globe Rupture
- Tear-shaped pupil
- Extrusion of intraocular content
- Orbital zygomatic fracture
- Most common
- Nasoethmoid fracture
- Damage to medial canthal ligament
- Damage to lacrimal duct
- Medial rectus entrapment
- Orbial Floor fracture
- Entrapment of inferior rectus
- Enophthalmos
- Damage to infraorbital nerve
- Retinal Detachment
- Hyphema
- Optic Nerve Sheath Hematoma
See Also
Source
Tintinalli's