Cold compression helps limit orbital edema and hemorrhage. The test is useful especially when it is done to judge the entrapment under general anesthesia during surgery.Ĭonservative observation is recommended when the patients have minimal diplopia with good motility, no evidence of muscle entrapment, no significant enophthalmos, or a small fracture that is unlikely to cause late enophthalmos. Severe edema or hematoma can mimic entrapment of tissues. A forced-duction test may help differentiate the causes of restriction of ocular movement, but one must be careful when interpreting the results. Serial evaluation of the diplopia field test and exophthalmometry are recommended as initial edema, hemorrhage and pain affect evaluation. Trapdoor fractures in pediatrics may not be noticed in CT scans, and in such cases, tear-drop sign ( See Figure 1B ), missing rectus sign, severe restriction of motion and oculocardiac reflex can be clues to diagnosing the fractures. Three-dimensional CT reconstruction helps define facial bone anatomy and fractures clearly. An orbital computed tomography, the gold standard in trauma, CT with contiguous thin axial and coronal sections should be ordered to confirm the diagnosis and plan for treatment ( See Figure 1A ). Plain X-ray films, although rarely used, with the Caldwell and Waters view may be done as a screening evaluation for possible fractures and foreign bodies. These symptoms may indicate ischemic damage of the entrapped muscle and suggest immediate surgical intervention.Įvaluation of patients with suspected orbital fracture should involve radiologic examination, motility test, diplopia field test and exophthalmometry. It can cause nausea, vomiting and bradycardia, especially in pediatric patients. Oculocardiac reflex may result from entrapment of muscle. Orbital emphysema is a benign, self-limited condition, but may be aggravated by nose blowing, sneezing or Valsalva maneuver. These include orbital hemorrhage and edema, muscular edema or hemorrhage, cranial nerve palsy and entrapment of soft tissue or muscle itself.Įntrapment of tissue occurs in minimally displaced linear or trapdoor fractures, whereas enophthalmos usually occurs in large burst-type fractures. Diplopia and limitation of ocular movement are caused by various conditions. Clinical signs include ecchymosis, crepitus, bone step-off, ptosis, enophthalmos and strabismus. Symptoms include pain with motility, diplopia with limitation of motion, hypesthesia and trismus. Then orbital fractures can be appropriately diagnosed and repaired.Ĭlinical presentations associated with orbital fractures vary in severity depending on the presence of ocular trauma and the location of the fracture. After the identification and treatment of life-threatening injuries, ophthalmologists should rule out serious ocular trauma. Other causes include motor vehicle crash, falls (especially in the elderly), sports and industrial accidents.Ī systematically and thoroughly obtained history and physical examination are most important in the evaluation of the traumatized patients. The causes of orbital fractures vary, but assault is the most frequent. Of orbital fractures, the inferior wall is most commonly involved, followed by the medial wall. Ophthalmologists most often get involved in pure orbital fractures with an intact orbital rim and without other facial bone fracture. Depending on the location and mechanism, intracranial, thoracic and abdominal injuries may be associated. Orbital fractures commonly occurby blunt, periocular trauma.
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