Orbital Fracture
Orbital fractures are common in head and facial trauma, often caused by blunt force trauma, car accidents, or falls. Based on the mechanism of injury, orbital fractures can be classified as direct fractures or indirect fractures, with the latter frequently presenting as blowout fractures.
Orbital Penetrating Injury
Sharp objects often cause penetrating injuries to the eyelids, eyeball, or deep orbital tissues. Damage to the extraocular muscles or their innervating nerves may result in restricted eye movement. Acute elevation of orbital pressure due to intraorbital hemorrhage can threaten vision.
Treatment
Soft tissue injuries should be managed with layered debridement and suturing, along with tetanus antitoxin and antibiotics to prevent infection. Acute orbital pressure elevation caused by hemorrhage requires immediate orbital decompression surgery.
Orbital Hemorrhage
Vascular rupture leading to intraorbital bleeding or hematoma formation is a common complication of orbital trauma. Hemorrhage may occur subperiosteally or within orbital tissues. Severe orbital hemorrhage is typically associated with orbital fractures but may also result from contrecoup injuries tearing intraorbital arterial branches or rupturing newly formed ciliary vessels.
Treatment
Observation is usually sufficient. Cold compresses or pressure bandages are applied initially, followed by warm compresses after 24 hours. Systemic hemostatic agents or antibiotics may be used. Decompression surgery is indicated if corneal exposure or vision loss occurs due to proptosis.
Orbital Emphysema
Orbital emphysema arises from orbital wall fractures and mucosal tears, allowing air accumulation in the eyelids or orbital tissues. This indicates communication between the orbit and paranasal sinuses. Causes include direct trauma (e.g., fists, wooden/metal objects, sports injuries) or indirect trauma (e.g., falls onto the occiput). Rarely, it occurs post-surgery. Orbital emphysema does not develop spontaneously but may emerge when upper respiratory pressure increases (e.g., sneezing, nose-blowing). Spontaneous cases without trauma history are rare.
Imaging
X-rays, CT scans, or MRI clearly demonstrate intraorbital air.
Treatment
No specific treatment is required. Pressure bandages and avoidance of forceful breathing are advised. Intraorbital air typically absorbs within days, resolving swelling.