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Blunt Injury: Orbital Wall Fracture

Orbital fracture x-ray

What is it?
A fracture in one or more of the bony walls of the orbit. In blunt trauma to the front of the orbit or the eye, the most common fracture site is the orbital floor (maxillary roof). Called a "blow-out fracture," it is shown as a discontinuity in the orbital floor on this CT. Less common fracture sites include the inferior orbital rim, and the medial and lateral walls.

In additional to eyelid swelling and ecchymosis, patients with blow-out fractures may develop entrapment of the inferior rectus muscle in the fracture site. This will cause limitation of upward or downward gaze. However, direct injury to the extraocular muscles—without fracture—may cause the same sign!

What to do?
Any patient with a history of a severe blow to the upper face or eye should undergo plain x-ray or CT examination to rule out facial and intracranial abnormalities.

An isolated orbital floor fracture need not be repaired unless severe limitation of eye movement or backward displacement of the eye persists after a 14-day waiting period. Referral within that period would be indicated only for baseline examination.

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