ORBITAL BLOW

OUT FACTURE
 Isolated communicated fractures which occur when orbital walls
are pressed indirectly .
 A break in the floor or the inner wall of the orbit.
 Mainly there is the involvement of orbital floor(maxillary,
zygomatic , palatine )and medial wall
(maxilla ,lacrimal ,ethmoid ,sphenoid ).
 Etiology
 Generally result from trauma to orbit by a relatively large ,rounded
object such as tennis ball, human fist etc.
 When an external force is applied to the orbital cavity from an
object whose diameter is larger than that of the orbit, the orbital
contents are compressed . The sudden rise in intraorbital pressure
is transmitted to the walls of the orbit, which ultimately leads to
fractures of the thin medial wall or orbital floor.
Classification

 Pure blow out fracture: these aren’t associated with the

involvement of orbital rim.
 Impure blow out fracture: these are associated with other
fractures about the middle third of the facial skeleton.
 Sign & Symptoms
 Orbital edema & blood extravasation(blood leakage).
 Orbital and lid subcutaneous emphysema, especially when blowing the nose or
sneezing
 Ipsilateral epistaxis: bleeding from the maxillary sinus into the nose.
 Proptosis because of the associated orbital edema and hemorrhage.
 Eyeball sinks (Enophthalmos) due to escape of orbital fat in maxillary sinus;
backward traction on the globe by entrapped inf. Rectus muscle and enlargement
of the orbital cavity .
 Seeing-double when looking up or down (vertical diplopia).
Evaluation & Diagnosis

 Visual acuity should be taken.

 Palpate orbital rim to look for deformity.
 Slit lamp evaluation of cornea and anterior segment .
 RAPD point towards the optic nerve injury.
 Fundus evaluation also should be done.
Cont.
 Forced duction test (FDT): It is useful in determining whether the
dysmotility is paralytic or restrictive.It is positive in blow out
fracture.
 Diplopia charting
 Imaging: plain X-rays shows the bony discontinuity in orbital floor.
 CT-SCAN gives detailed visualization of bony and soft tissue injury .
General Management

 Cold compression may decrease swelling by causing

vasocontriction.
 To prevent orbital emphysema, patients are advised to avoid
blowing of the nose.
 Systemic antibiotics can be given to prevent secondary infection
from the maxillary sinus
 Analgesics and anti inflammatory drugs can be given to decrease
pain and swelling
 Surgical Management
 Surgical repair to restore continuity of the orbital floor may be made with or
without implants . The optimal time for surgery when indicated is after 10 -14
days of injury .
 Indication for surgery:
i. Enophthalmos greater than 3 mm.
ii. Entrapment of extraocular muscles.
iii. Diplopia 0n primary and inferior gaze.
iv. Fracture involves greater than 50% of the orbital floor.
Presented by

 Raju ray Yadav

 Bindu mahato
 Kabita adhikari
 Sumitra gupta
 Kalpana Sharma
 Khushbu Shrestha
 Muskan gupta
 Jayanand mahato