Orbital Fractures: Symptoms, Causes, Treatment

What are the symptoms of orbital fractures?

Orbital fractures, which occur when there is a break in one or more of the bones surrounding the eye (the orbit), can present with a range of symptoms. The severity and type of symptoms may vary depending on the location and extent of the fracture. Here are some common symptoms associated with orbital fractures:

1. Periorbital Swelling and Bruising:

• Swelling around the eyes or the surrounding areas, often referred to as “raccoon eyes” if there is significant bruising.

2. Eye Pain:

• Pain around the eye or in the area of the fracture, which may worsen with eye movement or palpation of the surrounding tissues.

3. Diplopia (Double Vision):

• Difficulty with eye movements leading to double vision, especially if there is involvement of the extraocular muscles.

4. Restricted Eye Movement:

• Inability to move the eye freely, which may be due to muscle entrapment within the fracture site.

5. Enophthalmos:

• Sinking of the eyeball into the orbit, which can be a sign of volume loss in the orbit caused by bone loss.

6. Numbness or Altered Sensation:

• Numbness or a “pins and needles” sensation in the upper cheek, forehead, or upper lip if the fracture affects the infraorbital nerve or other branches of the cranial nerves.

7. Visual Disturbances:

• Changes in vision, such as blurred vision or decreased visual acuity, can occur and may signify more serious complications.

8. Eye Protrusion (Proptosis):

• In some cases, there may be proptosis (eye bulging), which is less common but can occur with significant trauma.

9. Tearing and Epiphora:

• Increased tearing or difficulty with tear drainage may occur if the tear drainage system is affected.

10. Nasal Symptoms:

• If the fracture involves the orbital floor, there may be associated nasal symptoms such as nasal discharge or bleeding.

Conclusion

Symptoms of orbital fractures can range from mild to severe and may include a combination of the above signs. Due to the potential for complications, including damage to the eye or surrounding structures, prompt evaluation and treatment by an eye care professional or a facial trauma specialist are important if an orbital fracture is suspected. Imaging studies, such as CT scans, are often used to confirm the diagnosis and assess the extent of the injury.

What are the causes of orbital fractures?

Orbital fractures result from various types of trauma to the facial region, particularly around the eyes. The specific causes can vary, but the most common include:

1. Blunt Trauma:

• Sports Injuries: Contact sports such as boxing, basketball, or football can lead to orbital fractures through direct hits to the face.
• Falls: Accidental falls, particularly in the elderly or individuals with balance issues, can cause significant impact to the face.
• Physical Assault: Fistfights or other forms of violence may lead to blunt force injuries to the facial area.

2. Motor Vehicle Accidents:

• Collisions can result in direct trauma to the face, especially in accidents where the airbag deploys or the face makes contact with steering wheels, dashboards, or windows.

3. Accidental Injuries:

• Everyday accidents, such as playing with toys, being struck by objects, or workplace injuries, can lead to inadvertent impacts around the eyes.

4. Penetrating Trauma:

• Gunshot Wounds: Firearms or other sharp objects can cause severe injuries, resulting in fractures of the orbital bones.
• Injury from Sharp Objects: Accidents involving knives or similar tools can lead to penetrating injuries.

5. Falls from Height:

• People falling from ladders, stairs, or other elevated surfaces may land on their face, leading to orbital fractures.

6. Sports Equipment:

• Objects such as golf balls, baseballs, or hockey pucks can cause direct impact to the eye area, resulting in fractures.

7. Explosions or Blast Injuries:

• Individuals exposed to blasts, such as in combat situations or industrial accidents, may suffer from multiple facial fractures, including orbital fractures.

8. Pre-existing Conditions:

• Certain medical conditions affecting bone density (such as osteoporosis) may make bones more susceptible to fractures from lower-energy injuries.

Conclusion

Orbital fractures are primarily caused by traumatic events, and understanding these causes can help promote safety measures to prevent such injuries. Wearing protective gear in sports, using seat belts in vehicles, and creating safe environments can reduce the risk of orbital fractures and associated complications. If an orbital fracture is suspected, prompt medical attention is crucial to minimize complications and ensure proper treatment.

How is the diagnosis of an orbital fracture made?

The diagnosis of an orbital fracture typically involves a combination of a thorough medical history, physical examination, and imaging studies. Here’s a breakdown of the diagnostic process:

1. Medical History:

• The healthcare provider will ask about the patient’s symptoms, the mechanism of injury, and any associated symptoms such as vision changes or neurological signs. Understanding how the injury occurred can provide important clues for diagnosis.

2. Physical Examination:

• The clinician will perform a detailed eye and facial examination. Key components of the exam may include:
  • Inspection: Looking for swelling, bruising, or deformity around the eye.
  • Palpation: Assessing tenderness or irregularities in the facial bones.
  • Visual Examination: Testing for visual acuity, checking for double vision (diplopia), and evaluating eye movements to assess if any extraocular muscles are affected.
  • Neurological Assessment: Checking for signs of nerve injury, such as changes in sensation around the eye or facial area.
  • Examination of the Pupils: Checking the reaction of the pupils can help rule out intraocular or neurological injuries.

3. Imaging Studies:

• If an orbital fracture is suspected, imaging studies are crucial for confirming the diagnosis and evaluating the extent of the injury. The following imaging modalities are commonly used:
  • CT (Computed Tomography) Scan: This is the gold standard for diagnosing orbital fractures because it provides detailed cross-sectional images of the skull and facial bones. CT scans can show the presence and extent of fractures, any associated conditions like hematomas, and potential involvement of the extraocular muscles.
  • X-rays: While traditional X-rays may be used in some cases, they are less effective than CT scans for visualizing orbital fractures.
  • MRI (Magnetic Resonance Imaging): In some situations, MRI may be used to assess soft tissue injuries, but it is less common for initial evaluation of bony fractures.

4. Consultation with Specialists:

• Depending on the severity and complications of the injury, the healthcare provider may refer the patient to an ophthalmologist or a facial plastic surgeon for further evaluation and treatment.

Conclusion

The diagnosis of an orbital fracture involves a systematic approach that includes gathering a detailed history, a thorough physical examination, and appropriate imaging studies. Early and accurate diagnosis is important to prevent complications and ensure appropriate management of the injury. If you suspect that you or someone else has an orbital fracture, seeking prompt medical care is essential.

What is the treatment for an orbital fracture?

The treatment for an orbital fracture depends on several factors, including the type and severity of the fracture, the patient’s symptoms, and any associated injuries. Here are general approaches to the management of orbital fractures:

1. Observation and Conservative Management:

• Minor Fractures: In cases where there is no significant displacement of bone fragments, minimal symptoms, and no involvement of the optic nerve or extraocular muscles, conservative management may be appropriate. This can include:
  • Rest: Allowing the body to heal without unnecessary strain on the eye.
  • Cold Compresses: Applying cold packs to reduce swelling and bruising.
  • Pain Management: Over-the-counter pain medications, such as acetaminophen or ibuprofen, can help alleviate discomfort.
  • Avoiding Activities: Refraining from activities that may increase intraocular pressure or cause strain, such as heavy lifting or intense physical activity.

2. Surgical Intervention:

• Indications for Surgery: Surgical treatment may be necessary in cases where:
  • There is significant displacement of the fragments.
  • There is entrapment of the extraocular muscles, leading to restricted eye movement and diplopia (double vision).
  • There are concerns about potential vision loss due to pressure on the optic nerve.
  • There is a large fracture that may cause cosmetic deformities.
• Surgical Techniques:
  • Orbital Reconstruction: This typically involves the repositioning of displaced bone fragments and may include the use of implants or grafts to restore the structural integrity of the orbit.
  • Decompression Surgery: If there is severe swelling or pressure on the optic nerve, a decompression procedure may be performed to relieve pressure.
  • Repair of Entrapped Muscles: If extraocular muscles are entrapped, the surgeon may release them during surgery to restore normal eye movement.

3. Follow-Up Care:

• Monitoring Recovery: Close follow-up is essential to assess the healing process and address any complications. This may include regular eye examinations or imaging studies.
• Management of Complications: If complications arise, such as persistent diplopia, vision changes, or infection, additional treatments may be required.

4. Rehabilitative Care:

• Vision Therapy: In cases where double vision persists, vision therapy or prism lenses may be recommended to improve eye coordination.
• Physical Therapy: Depending on the severity of the injury and any associated issues, physical therapy may be beneficial.

Conclusion

Orbital fractures are managed on a case-by-case basis, with treatment strategies ranging from conservative observation to surgical intervention based on the specific circumstances of the injury. Early diagnosis and appropriate treatment are crucial for optimizing outcomes and minimizing complications. If an orbital fracture is suspected, it’s important to seek medical attention promptly for proper evaluation and management.