Orbital Trauma

Orbital Trauma

Joshua Gentges

Douglas Marx


The orbit is defined by the bony structures that form the orbital floor and wall. It contains and protects many important soft tissue structures, including the eye, extraocular muscles, blood vessels, fascia, ligaments, and cranial nerves (CN) to the orbital structures and face.1 It also contains the eyelids, tear glands, and lacrimal glands (Figure 28.1). Because of the complex bony and soft tissue anatomy, trauma can lead to significant intraocular and extraocular pathology. Careful attention to a focused history and physical examination is important, because missed orbital trauma may lead to loss of vision, intracranial infection, or death in the setting of penetrating orbital injuries.2

The diagnosis of orbital injuries is not always apparent because trauma patients may have distracting injuries, have altered mental status, or be unable to participate in a complete examination. Injuries to the orbit can cause orbital fractures, which can lead to organ threatening pathology, including orbital compartment syndrome (OCS), entrapment of extraocular muscles and other intraorbital tissue, globe rupture, vascular injury, optic neuropathy, or nerve avulsion. Evaluation for entrapment of orbital contents is particularly challenging in trauma patients. External signs of injury may not be present in all cases. OCS is clinically challenging because it is both rare (0.088% of craniomaxillofacial [CMF] injuries) and devastating, leading to vision loss that is progressive with increased time to intervention.2,3,4

Nov 11, 2022 | Posted by in EMERGENCY MEDICINE | Comments Off on Orbital Trauma

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