Disease Description (Causes and Symptoms)
- Definition: An orbital fracture is a condition in which the bones of the orbit surrounding the eye are ruptured or depressed due to trauma, damaging the thin bones that protect the eyeball and structures around it.
- Causes/Pathophysiology: It occurs when a direct impact to the face, such as from a traffic accident, assault, or sports injury, ruptures the orbital wall—especially the orbital floor or medial wall—or when orbital tissues (subcutaneous tissue, fat, extraocular muscles, etc.) herniate through the fracture fragments. In children, a “trapdoor” fracture may trap a muscle, causing impaired blood flow and mechanical restriction.
- Main symptoms: Diplopia (seeing double), restricted eye movement, changes in vision (decreased vision), enophthalmos (posterior displacement/recession of the eyeball), swelling and bruising around the eye and eyelids, subconjunctival hemorrhage, decreased facial sensation (jaundice nerve distribution), nosebleed, and, in some cases, orbital emphysema (swelling caused by air entering the orbit).
- Key points for diagnosis: A detailed eye examination (visual acuity, pupillary response, extraocular muscle movement, and measurement of ocular protrusion), a forced duction test when an entrapped muscle is suspected, and noncontrast, high-resolution orbital (or facial) CT with thin axial, sagittal, and coronal sections are central to diagnosis.
Treatment Methods
- Nonsurgical treatment (initial conservative treatment)
- Immediate first aid: Ocular rest, cold compresses around the eye (to reduce swelling), and rest with the head elevated.
- Infection prevention: Antibiotics (e.g., amoxicillin/clavulanate) may be considered when the fracture communicates with the maxillary sinus.
- Pain control: Acetaminophen is preferred initially; consult a doctor if taking anticoagulants or antiplatelet drugs.
- Steroids: Short-term use may be considered in cases of severe swelling or suspected optic nerve compression (at the specialist’s discretion).
- Precautions: Ophthalmic treatment is required if conjunctival or ocular surface damage is also present; do not blow your nose (as this can worsen orbital emphysema by introducing air).
- Surgical treatment (indications and timing)
- Indications for immediate (emergency) surgery: If the eye muscle is trapped by fracture fragments with suspected impaired blood flow or persistent extraocular muscle paralysis, or if an oculocardiac reflex (nausea, fainting, or bradycardia) occurs, surgery should be performed as quickly as possible (within 24–48 hours).
- Recommended early surgery (within 10–14 days): When severe diplopia persists or enophthalmos is progressing.
- Purpose of surgery: To remove bone fragments and decompress the area, restore herniated tissue, and reconstruct the orbital structure (using artificial implants such as mesh, silicone, or other physical implants) to restore the position of the eyeball and extraocular muscle function.
- Postoperative care: Antibiotics to prevent infection, management of swelling and pain, eye-movement rehabilitation (including treatment to correct vision and diplopia), and monitoring of the recovery of facial sensation.
- Prevention and follow-up of complications: Regularly monitor changes in vision, persistent diplopia, enophthalmos, and sensory abnormalities (with collaboration between oculoplastic and ophthalmology specialists).
Outpatient Visit Checklist (Items to Bring and Test Preparation)
- Items to bring
- A list of currently used medications (including anticoagulants, antihypertensive drugs, and steroids) and a history of allergies
- A record of how the accident occurred (time and circumstances) and when symptoms began
- Photographs taken at the time of the injury, if possible; previous tests (X-rays/CT scans taken if necessary) and medical records
- Notes on when changes in vision began and the seasonal pattern or pattern of worsening and improvement of symptoms
- Tests that may be performed during the outpatient visit
- Visual acuity testing, pupillary and fundus examinations, assessment of extraocular muscle movement, and measurement with a Hertel exophthalmometer
- Noncontrast orbital and facial CT (to identify detailed fractures and tissue herniation)
- Forced duction testing and intraocular pressure measurement, if necessary
- Instructions before the visit
- Do not blow your nose, lift heavy objects, or engage in strenuous exercise
- If there is a risk of bleeding, manage hemostasis and consult the treating doctor about any anticoagulants being taken
Examples of General Questions to Ask the Doctor
- “Is this type of fracture one that requires surgery? Depending on the circumstances, when do you recommend surgery?”
- “If I do not undergo surgery, what complications (such as diplopia, enophthalmos, or vision loss) may remain?”
- “What is the success rate of the surgery and the expected recovery period?”
- “What are the side effects and duration of use of the prescribed medications (such as antibiotics and steroids)?”
- “When can I shower and return to work and exercise in daily life?”
Examples of Disease-Specific Questions
- “If eye movement is restricted and I have diplopia, how will you determine whether a muscle is entrapped, and if entrapment is confirmed, how urgently is surgery needed?”
- “My eyeball appears to be displaced backward (enophthalmos). To what extent can surgery restore its position? How likely is it to persist in the long term?”
Additional guidance: If symptoms such as decreased vision, severe extraocular muscle restriction, vomiting, or severe bradycardia are present, the patient must be transferred without delay to an emergency ophthalmology, oculoplastic, or trauma center for immediate evaluation.