The double vision and numbness of the cheek, upper lip and gum should improve with time as the swelling and bruising subside. The enophthalmos should improve after surgical correction of the blow-out fracture. Bruising and swelling may be expected which will likely resolve within 2-3 weeks. Generally, some patients may experience post-operative discomfort, which can be relieved by analgesics. With this type of condition early surgery is of great significance and patients must be seen within a few days after the injury for a higher surgical success rate.Īs each case is different, please ask Dr Martin what you should expect following surgery. the eye appears shrunken in the orbit as the swelling subsides), the involvement of eye muscles and the size of the fracture. Hese include: the persistence of double vision, the presence of enophthalmos (i.e.
There are several factors which influence the indication and timing of surgery. However, not all blow-out fractures have to be repaired surgically. What is the treatment for a Blow-Out Fracture?īased on the complete evaluation, Dr Martin may recommend surgical correction of the blow-out fracture. A CT scan will also be required to assess the extent of the fracture. double vision apparent only when looking up).ĭr Martin and his orthoptist will perform a complete eye examination to determine whether any further damage to the eye has been sustained. The double vision, if present, may be constant or only in certain eye positions (e.g. Symptoms include bruising around the eye, protrusion of the eye and/or numbness of the cheek, upper lip and gum. What are the symptoms of a Blow-Out Fracture? Any other blunt trauma to the eye which increases the pressure inside the orbit can also cause this type of injury. It can also be due to a motor vehicle accident, where the eye strikes the dashboard of the car. Rarely fragments from an orbital floor fracture buckle up into the orbit, an injury referred to as a "blow-in" fracture.An orbital fracture is typically caused when a fist or ball strikes the eye. It has been presumed that fracture of the orbital floor may impede blood supply to the inferior orbital fat, leading to anaerobic cellulitis 2. Surgery is rarely needed for medial wall fractures. Generally, blowout fracture-related orbital cellulitis can occur following paranasal sinus infection preexisting or occurring within several weeks after the fracture. The treatment of pure orbital blow-out fractures is often conservative but orbital floor repair may be necessary if there are complications such as inferior rectus muscle compromise. In the supine position, fluid and debris in the maxillary antrum can layer against the orbital floor and obscure soft tissue herniating through the fracture.For those patients in whom direct coronal scans are not possible (for example due to other injuries or if the patent is unable to co-operate), axial CT scans with coronal reconstructions are an alternative method of imaging, particularly with the use of multidetector CT. Direct coronal CT scans (with the patient prone) are best for demonstrating blow-out fractures. A CT scan is indicated if there is diplopia or restriction of eye movements, and to assess the extent of the injury. Mild or transient diplopia can occur simply due to the periorbital oedema or haemorrhage. If the inferior rectus muscle or its sheath herniates through the fracture and becomes trapped, it may be compromised resulting in diplopia on looking down or straight ahead. The fracture fragments are rarely demonstrated on plain films. An air-fluid level may be seen in the maxillary sinus. Other signs of a blow-out fracture are air within the orbit (which has entered from the maxillary or ethmoid sinuses), an indistinct orbital floor on occipitomental views and opacification of the sinuses due to blood within them. This appearance has been likened to an opaque tear drop hanging from the roof of the antrum and may be the only radiographic evidence of a blow-out fracture. On occipitomental (facial) x-rays this is seen as a convex mass projecting into the roof of the right maxillary sinus. Orbital contents may then herniate downwards through the orbital floor fracture into the maxillary sinus. The orbital rim remains intact in pure blow-out fractures.
These are the thin plates of bone that form the orbital floor (roof of the maxillary antrum) and the medial wall of the orbit (lateral wall of the ethmoid sinuses). There is an acute increase in intraorbital pressure which is relieved by fracture through the weakest parts of the orbit. A blow-out fracture of the orbit results from a direct compressive force to the eye, e.g.
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