ORBITAL BLOW-OUT FRACTURES

KEERTHI N S

2010 BATCH

Are isolated comminuted fractures that occur when the orbital walls are pressed indirectly

Mainly involve floor and medial wall

ETIOLOGY

Trauma by BLUNT OBJECTS like Tennis ball Cricket ball Human fist Part of automobiles

MECHANISM OF FRACTURE

Force of blow backward displacement of eyeball intraorbital pressure increases fracture in the weakest point of orbital wall

CLASSIFICATION

1. PURE BLOW-OUT FRACTURES

2. IMPURE BLOW-OUT FRACTURES

EFFECTS OF ORBITAL FLOOR FRACTURE

1. Herniation of orbital contents

2. Entrapment of inferior rectus

3. Damage to infraorbital nerve

CLINICAL FEATURES

Pain Diplopia Epistasis

SYMPTOMS

SIGNS

EARLY SIGNS Peri orbital ecchymosis Emphysema of lids Paraesthesia and anaesthesia Ipsilateral epistasis Proptosis

LATE SIGNS Enopthalmos and mechanical ptosis Diplopia

X rayCTMRI

ORBITAL IMAGING

Plain X rays

Water’s view

Findings: Fragmentation and

irregularity of orbital floor

Hanging drop opacity

Coronal Computerised tomography

CTs are diagnostic method of choice

Coronals provide best view CT can show

Herniation of fat into maxillary sinus

Magnetic resonance imaging

extraocular muscle rounding

MANAGEMENT

General measures and medical:

Avoid nasal blowing Systemic antibiotics Analgesis Anti inflammatory drugs Cold compresses

Surgical management

Indications:- Diplopia not resolving Large herniation of

tissues to antrum Retracted globe and

applanation tension Enophthalmos

Aim: To restore the continuity

of floor with or without implants(silicone rubber layer)

Time: After 10-14 days of injury