Orbital Floor Blowout Fracture – Treatment Options

by Dr. Jason Hamilton

 

What are my treatment options for an orbital blowout fracture?

Question: I currently play baseball for my local university and was injured during our last game a few days ago. I was attempting to catch a ball when the sun momentarily blinded me. The baseball hit me in the eye and I developed severe swelling and bruising. I was taken to a local emergency room where I was told that I had an orbital wall fracture and would need to rest and avoid contact sports for several weeks but that my vision seemed to be fine. I have started to worry about my eye and would like to know what my treatment options are for an orbital wall fracture.

Figure 1. Illustration depicting the left bony orbit. The circular orbit is divided into four walls. Fractures involving the orbit most commonly affect the orbital floor (inferior wall).

Figure 1. Illustration depicting the left bony orbit. The circular orbit is divided into four walls. Fractures involving the orbit most commonly affect the orbital floor (inferior wall).

Discussion:

There are several options for treatment of an orbital wall fracture. In cases of minor fractures, if the patient does not have any apparent changes in vision or pain during eye movement, observation during healing is recommended and more advanced intervention is not required. Larger fractures in which the eye commonly appears to be sunken in or if pain is felt with movement, require more extensive techniques for treatment. In some cases small and thin flexible endoscopes are introduced through the nasal sinus and repairs can be made to the orbital bones without leaving any visible external scars. In other cases where trauma is more extensive, small incisions can be made under the eyelashes or to the inside of the eyelid in order to gain access to the orbital walls. Factors that can affect treatment choice include the location of the fracture, extent of the damage, changes in vision and pain with eye movement. In all cases, a facial trauma specialist can advise you as to a specific and detailed treatment plan for your specific injury.

In all cases of facial trauma, timely evaluation is paramount to ensure proper healing of your injuries. Orbital trauma is especially time sensitive in preserving vision and eye movement. In most cases of orbital trauma, a CT scan is ordered to evaluate for any fractures to the orbital walls or damage to the adjacent brain tissues. Usually the extent of underlying damage is not readily evident from superficial examination due to the effects of swelling. Sunken eyes, for example, will commonly not be evident for weeks until swelling has dissipated. In other cases bone fragments can become lodged between the muscles responsible for moving the eyes, causing severe pain with movement.

Figure 2a,2b. An example of a patient presenting with a right orbital floor blowout fracture. Bruising and limited eye movements secondary to swelling are common clinical presentations (top). CT scan demonstrates common findings of a blow out fracture with evidence of a depressed right orbital floor (bottom).

Figure 2a,2b. An example of a patient presenting with a right orbital floor blowout fracture. Bruising and limited eye movements secondary to swelling are common clinical presentations (top). CT scan demonstrates common findings of a blow out fracture with evidence of a depressed right orbital floor (bottom).

The physicians of the Osborne Head and Neck Institute Division of Facial Plastic and Reconstructive Surgery commonly perform orbital blow out repair procedures. Their unique qualifications and experience afford them the ability to use innovative and cutting edge procedures in treating facial trauma. Due to their tireless pursuit of superior results and patient satisfaction, the physicians of the Osborne Head and Neck Institute have gained international acclaim for their diagnostic and treatment acumen.

To learn more about the treatment for orbital blowout fractures please visit us at facialtraumamd.com or fill out the contact form below to schedule an appointment.

Key Points:

  • There are various options for treatment of orbital wall fractures most of which are dependent on severity of trauma, changes in vision, and location of fracture.
  • Minor fractures that do not include damage to the eye, pain, or significant cosmetic change are generally observed without further intervention.
  • More extensive fractures generally require intervention by repositioning or replacing broken bones through small incisions in the eyelid.
  • In all cases of facial trauma, evaluation by a qualified facial trauma specialist is recommended.

Contact a Physician at Osborne Head & Neck Institute

If you would like to speak with one of our physicians regarding this issue or another ear, nose, throat problem; or have other questions or concerns, please complete the contact form below or call us at 310-657-0123.

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