Finally, the orbital injury can lead to retinal edema, hyphema, and significant loss of vision. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze, and tethering. The problem with orbital blowout fractures is that the volume of the orbit can be increased, resulting in enophthalmos and hypoglobus. The goal of treatment is to restore aesthetics and physiological function. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles. Located around the globe of the eye and attached to it are 6 extraocular muscles the 4 rectus muscles and the superior and inferior oblique muscles. Superior and inferior borders are the frontal and maxillary bones. The zygomatic bone forms the lateral wall. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The sphenoid bone forms the posterior wall and houses the orbital canal. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Diplopia, nausea, vomiting with no subconjunctival haematoma in a young patient requires immediate referral. The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. CT findings in a right sided white eye blowout fracture with entrapment of orbital tissue (arrow) These injuries must be treated within 48 hours otherwise permanent restriction of ocular motility may occur. Knowledge of anatomy is mandatory when dealing with patients presenting with trauma to the orbit. Orbital fractures have a distinct trauma mechanism and are complex due to the complex anatomy of the bony and soft tissue structures involved. Serious consequences of such injury include diplopia on downward gaze if there is damage to the floor of the orbit.Fractures of the orbital floor and the medial orbital wall (blowout fractures) are common midface injuries. The force of a blow to the orbit is dissipated by a fracture of the surrounding bone, usually the orbital floor and/or the medial orbital wall. The term "blow out fracture" was coined in 1957 by Smith & Regan, who were investigating injuries to the orbit by placing a hurling ball on cadaverous orbits and striking it with a mallet. This is most commonly caused by blunt trauma of the head, generally personal altercations. Intraorbital material may be pushed out into one of the paranasal sinuses. OverviewĪ blowout fracture is a fracture of the walls or floor of the orbit. List of terms related to Blowout fractureĮditor-In-Chief: C. This injury can sometimes heal with remedies, like ice, rest, and more. Risk calculators and risk factors for Blowout fractureĬauses & Risk Factors for Blowout fracture A right orbital fracture is a break to the bones surrounding your right eye. US National Guidelines Clearinghouse on Blowout fractureĭirections to Hospitals Treating Blowout fracture Ongoing Trials on Blowout fracture at Clinical Ĭlinical Trials on Blowout fracture at Google It is seen in children and young adults due to the elasticity of the orbital floor. 1, 2 In adults, motor vehicle accidents and assault are the most common mechanisms of injury. A trapdoor fracture is a fracture of the orbital floor where the inferiorly displaced blowout fracture recoils back to its original position and potentially entraps contents of the orbit. Articles on Blowout fracture in N Eng J Med, Lancet, BMJĬochrane Collaboration on Blowout fracture Most orbital fractures occur in males in their second decade of life.
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