An orbital blow-out fracture consists of a fracture of the bones of the eye “socket”. This may involve the orbital floor, walls, or roof. Most cases, however, involve the orbital floor. An orbital blow-out fracture is almost always secondary to a blunt blow from a relatively large object, such as a fist, elbow, baseball bat, etc. Most patients will present with pain, tenderness around the eye, swelling, and double vision in some fields of gaze. Pain with attempted eye movement is also common.
The ophthalmologist will evaluate the eye carefully to be certain that eye trauma is detected, and if present, appropriately treated. Next, the motility (movement) of the affected eye is evaluated, as is a determination as to whether double vision occurs in any field of gaze. This last finding, if present, may significantly effect management of the condition.
A CT scan is often obtained, depending on the initial presentation, to determine the presence or absence of
fracture. If the patient has double vision, one of the extra-ocular muscles of the eye (muscles which move the eye), may be entrapped in the fracture. However, patients with significant swelling and hemorrhage in the orbit may also have restriction of eye motility, and double vision alone is not necessarily an indication for surgical repair of the fracture.
Some ophthalmologists recommend early surgical repair (within the first few days) of orbital fractures which are associated with double vision and muscle entrapment, while others recommend waiting one to two weeks for repair.
Patients are usually instructed to avoid blowing their nose and may be instructed to use nasal decongestants. Also, patients are usually treated with oral antibiotics to reduce the risk of orbital infection.
Possible Tests to Confirm Diagnosis
- Alignment tests
- Slit-lamp examination
- Visual acuity