Orbital emphysema or crepitus if the fracture involves the sinuses.Loss of sensitivity in the area innervated by the infraorbital nerve.Restricted ocular movement can lead to diplopia: If the orbital tissue is prolapsed inferiorly, upward gaze is impaired.Unilateral periorbital pain, edema, and/or ecchymosis.Mechanism of injury: high-velocity blunt trauma to the globe and upper eyelid (e.g., from a punch, tennis ball, etc.) that causes an indirect downward force to the infraorbital groove.Definition: Orbital contents are typically forced through a fractured orbital floor ( blowout fracture).Orbital floor fracture (blowout fracture) Sympathetic ophthalmia: bilateral granulomatous panuveitis after unilateral penetrating injury (and rarely after intraocular surgery ) → bilateral blindness may occurĪvoid topical ointments in the presence of open globe injuries.Endophthalmitis : inflammation of the tissues or fluid inside the eye (especially with retained intraocular foreign bodies), often presenting with deep ocular pain, a red eye, and reduced visual acuity.Urgent ophthalmologic consultation for surgical repair.Systemic antibiotic therapy for foreign bodies.Analgesia (e.g., IV morphine), antiemetics (e.g., IV ondansetron), and tetanus vaccine or booster.Culture of the vitreous if a foreign body or infection is suspected.Nonenhanced CT can be used if the eye cannot be directly visualized or to exclude the possibility of an intraocular foreign body.Fluorescein stain if inconclusive: corneal abrasions and foreign bodies.Careful investigation of the anterior and posterior segment of the eye (by slit lamp and fundoscopy, respectively).All sequelae of ocular contusion are possible (see above).Afferent pupillary defect and impaired visual acuity.Gross deformity of the eye (ocular rupture with fluid volume loss) or prolapsing uvea ( full-thickness laceration ).Mechanism of injury: sharp objects or high-velocity blunt objects.Definition: full-thickness perforation or laceration of the ocular globe.Because of the risk of retinal detachment, ophthalmological follow-up is necessary for the rest of the patient's life.Specific treatment depends on the precise injury.Eye immobilization if necessary (with a binocular bandage).Fluorescein stain to determine corneal abrasions and/or foreign bodies.Prognosis/Complications: usually resolves in 3–4 weeks without treatment.Diagnosis: fundoscopy showing retinal swelling and whitish clouding with possible bleeding.Clinical features: decreased vision a few hours after the injury.Definition: traumatic edema of the macula and retina following ocular contusion.Rupture of the cornea or root of the iris ( iridodialysis), mydriasis, iritis.Conjunctival or partial thickness laceration of the cornea or sclera.Subconjunctival, vitreous, or retinal hemorrhage.Conjunctival and corneal abrasion (sensation of foreign body in eye).
#BLOWOUT FRACTURE FULL#
Definition: closed globe injury which occurs in the absence of a full thickness ocular wall laceration or rupture.Urgent stabilization, antibiotics, and immediate ophthalmologic consultation is often required to rule out serious injury (e.g., severe chemical burns, open globe injuries, retinal detachment, extraocular muscle entrapment) and determine the need for surgery. Chemical burns require immediate and adequate irrigation with water beginning prior to hospitalization. Treatment of traumatic eye injuries depends on the precise underlying injury. Chemical burns of the eye present with ocular pain, erythema, and blepharospasm. Orbital floor fractures are a type of periocular injury following high-velocity blunt trauma to the globe and upper eyelid which present with unilateral periorbital pain, edema, and/or ecchymosis, enophthalmos, and an orbital rim “ step-off” which is confirmed by CT. Open globe injuries usually follow sharp or high-velocity blunt trauma and present with ocular volume loss or a prolapsing uvea in addition to the sequelae of closed ocular injuries. Closed globe injuries usually follow blunt trauma and have a varied clinical presentation ( superficial corneal abrasion to retinal hemorrhage). Common traumatic eye injuries occur through blunt or sharp objects or chemical burns. The eye is a highly sensitive organ that is well-protected by the bony orbit and eyelid.
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