Highlights & Basics
- Orbital fractures are traumatic injuries usually caused by assault, sports, or accidents.
- A careful evaluation of the orbit injury may include examination of the facial bones, eyelids, and surrounding soft tissue; inspection of the globe; and visual acuity.
- A definitive diagnosis is confirmed by computed tomography scan of the orbit.
- Urgent surgery is indicated in pediatric patients with signs of soft tissue (muscle) entrapment; namely upgaze limitation and the oculovagal response (presence of vagal stimulation by pressure to intraorbital structures, which results in bradycardia, hypotension, and nausea and/or vomiting). Surgery is delayed in most adult cases to allow edema and hemorrhage to resolve. In small, non-blowout fractures, conservative treatment may be considered.
- The use of goggles or safety glasses in contact sports is recommended to prevent orbital fractures and associated injuries.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Orbital bone anatomy
Pediatric blowout fracture: patient looking in central gaze. Mild right circumorbital ecchymosis is noted
Pediatric blowout fracture: patient looking in upward gaze. Right globe limitation by inferior soft tissue entrapment is noted
Right orbital blowout fracture; teardrop sign on occipitomental 15° x-ray
Right orbital blowout fracture on CT-scan; coronal reformat
Right orbital blowout fracture on CT-scan; sagittal reformat
No evidence of fracture on the left orbit as seen on CT-scan; sagittal reconstruction
Citations
Manolidis S, Weeks BH, Kirby M, et al. Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions. J Craniofac Surg. 2002 Nov;13(6):726-37.[Abstract]
Cobb A, Murthy R, Manisali M, et al. Oculovagal reflex in paediatric orbital floor fractures mimicking head injury. Emerg Med J. 2009 May;26(5):351-3.[Abstract]
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5. Manolidis S, Weeks BH, Kirby M, et al. Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions. J Craniofac Surg. 2002 Nov;13(6):726-37.[Abstract]
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10. Ko MJ, Morris CK, Kim JW, et al. Orbital fractures: national inpatient trends and complications. Ophthalmic Plast Reconstr Surg. 2013 Jul-Aug;29(4):298-303.[Abstract]
11. Cobb A, Murthy R, Manisali M, et al. Oculovagal reflex in paediatric orbital floor fractures mimicking head injury. Emerg Med J. 2009 May;26(5):351-3.[Abstract]
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15. Ethunandan M, Evans BT. Linear trapdoor or "white-eye" blowout fracture of the orbit: not restricted to children. Br J Oral Maxillofac Surg. 2011 Mar;49(2):142-7.[Abstract]
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