Orbital Wall Fracture

What's going on?

Severe sudden pressure on the globe causes a massive increase in pressure within the orbit. This pressure causes fracture of one or more of the bony orbital walls, with prolapse of orbital tissue into the adjacent sinuses. Enophthalmos occurs, and there will be some restriction of ocular movement, particularly looking up and down.

If I examine the patient, what will I find?

Oculomotility will be restricted, particularly when the patient attempts to look up or down. The patient's cheek may be numb, owing to compromise of the infraorbital nerve. The eye may appear retracted. There may be surgical emphysema (air under the skin).

What if I've diagnosed it?

Refer the patient to a maxillofacial surgeon and ophthalmologist for assessment.

What will the hospital do?

Imaging will be used to assess the extent of injury and surgery planned as appropriate.

What do I need to do?

Warn the patient against blowing their nose, as this will force air, and possibly infective organisms, into the orbit.

Problems that may arise, and how to deal with them

If the orbit suddenly becomes red and painful, the patient may have developed infective orbital cellulitis (see below), requiring intravenous antibiotics.