General Medical Information

Orbital Trauma

Jean Edwards Holt

Trauma to the orbit can be superficial, resulting in only ecchymosis of the lid (black eye), or it can be extensive, involving the bony walls and intraocular structures. Plain radiographs of the orbits are of limited value after orbital trauma except for localizing embedded metallic foreign bodies. Computed tomography (CT), both axial and coronal, provides the best information about osseous components of trauma. Soft-tissue window algorithms can be used to assess hematoma formation, orbital fat prolapse, and other damage. Evidence of orbital emphysema on CT scans usually is a result of orbital continuity with fractured sinuses. Although the air usually resorbs spontaneously, increased IOP and retinal artery compression can occur. Evaluation of extraocular muscle function can show soft-tissue entrapment in an orbital floor fracture. Subcutaneous emphysema in the eyelids can indicate a medial wall fracture into the ethmoid air cells. Visual acuity should be documented. A decrease may indicate ocular damage. More than 30% of injuries to the bony orbit are associated with intraocular injury. If the injury is superficial or if the findings at radiography, motility studies, visual acuity testing, and globe inspection are normal, the patient can be reassured. Otherwise, a referral can be made for surgical care or further ocular examination.