Oxford Handbook of Emergency Medicine by Jonathan P. Wyatt;Robert G. Taylor;Kerstin de Wit;Emily J. Hotton;

Author:Jonathan P. Wyatt;Robert G. Taylor;Kerstin de Wit;Emily J. Hotton;
Language: eng
Format: epub, pdf
Publisher: Oxford University Press USA
Published: 2020-02-15T00:00:00+00:00

Orbital ‘blow-out’ fractures

This is caused by a direct blow to the globe of the eye (commonly from a squash ball or a shuttlecock), resulting in a fracture of the orbital floor and prolapse of contents into the maxillary sinus.

Examination

Check for diplopia due to inferior rectus entrapment ( patient cannot look up and medially), enophthalmos, and surgical emphysema. Carefully check the eye itself for injury (hyphaema, retinal detachment, glaucoma, blindness). Record the VA. Test infra-orbital nerve function. Fractures of the floor of the orbit may not be easily visible on X-ray but can often be inferred by the soft tissue mass in the roof of the maxillary sinus (‘tear drop’ sign), clouding of the sinus, and surgical emphysema.

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