Orbital Roof Fractures
Orbital roof fractures are usually caused by blunt trauma or missile injuries. They are more common in young children, in whom the frontal sinus has yet to pneumatize. Because the ratio of the cranial vault to the midface is greater in children than in adults, frontal impact is more likely to occur with a fall. By contrast, frontal trauma in older individuals is partially absorbed by the frontal sinus, which diffuses the force and prevents extension of the fracture along the orbital roof. Complications of orbital roof fractures include intracranial injuries, cerebrospinal fluid rhinorrhea, pneumocephalus, pulsatile proptosis, subperiosteal hematoma, ptosis, and extraocular muscle imbalance. In roof fractures, the entrapment of extraocular muscles is rare, with most early diplopia resulting from hematoma, edema, or contusion of the orbital structures. In severely comminuted fractures, pulsating exophthalmos may occur as a delayed complication. Young children may develop nondisplaced linear roof fractures after fairly minor trauma, which may present with delayed ecchymosis of the upper eyelid. Most roof fractures do not require repair. Indications for surgery are generally neurosurgical, and treatment often involves a multidisciplinary team.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.