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Orbital Fracture in Emergency Medicine Follow-up

  • Author: Thomas Widell, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Oct 23, 2014
 

Further Outpatient Care

Patient with simple blow-out fracture without eye injury can be discharged home, even if patient has signs of entrapment, because most resolve as swelling goes down. Instruct patient to return if he or she notes a change in visual acuity, increasing pain, or flashing lights.

Follow-up exam in 2 weeks allows for swelling to resolve. If entrapment is confirmed at that time, open reduction of fracture with bone graft may be needed.

Because the incidence of posttraumatic stress disorder is high, referral to a psychiatrist should be considered if symptoms occur.[10]

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Further Inpatient Care

Blow-out fractures without associated serious eye injury do not require admission.

Admit patient with serious eye injury to ophthalmology service for further care, unless other significant injuries mandate admission to trauma service.[4]

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Transfer

If appropriate specialists are not available in the receiving institution, arrange transfer to a higher level hospital.

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Deterrence/Prevention

Use safety glasses at work and while participating in sports that use balls or pucks to reduce incidence of blow-out fractures.

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Complications

See the list below:

  • Corneal abrasion
  • Lens dislocation
  • Iris disruption
  • Choroid tear
  • Scleral tear
  • Ciliary body tear or bruise
  • Retinal detachment and tear
  • Hyphema
  • Ocular muscle entrapment
  • Globe rupture
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Patient Education

Instruct patients to use ice to reduce edema.

Instruct patient to return if visual problems develop.

If injury occurred at work or in a sporting accident, instruct patient to wear safety glasses or goggles.

For patient education resources, see the Breaks, Fractures, and Dislocations Center, as well as Facial Fracture.

Patients should be informed of the high risk of posttraumatic stress disorder and should be referred to a psychiatrist should symptoms occur.[10]

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Contributor Information and Disclosures
Author

Thomas Widell, MD Vice Chairman, Assistant Professor, Department of Emergency Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science; Associate Residency Director, University of Chicago Emergency Medicine Program; Program Director, Emergency Medical Education, Attending Physician, Mount Sinai Hospital Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Michelle Ervin, MD Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Hendler BH. Maxillofacial trauma. Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998. 1093-1103.

  2. McGill J, Ling LJ, Taylor S. Facial trauma. Diagnostic Radiology in Emergency Medicine. Mosby-Year Book; 1992. 51-76.

  3. Smith RG. Maxillofacial injuries. Harwood-Nuss A, ed. The Clinical Practice of Emergency Medicine. Lippincott Williams & Wilkins Publishers; 1996. 408-418.

  4. Spoor TC, Ramocki JM, Kwito GM. Ocular trauma. Wilson RF, Walt AJ, eds. Management of Trauma: Pitfalls and Practice. 2nd ed. Lippincott, Williams & Wilkins; 1996. 225-241.

  5. Sullivan WG. Trauma to the face. Wilson RF, Walt AJ, eds. Management of Trauma: Pitfalls and Practice. Lippincott, Williams & Wilkins; 1996. 242-269.

  6. Hasan N, Colucciello SA. Maxillofacial trauma. Tintinalli JE, Gabor KD, Stapczynski SJ, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw-Hill Co Inc; 2004. chap 257, p1583-1.

  7. McKay MP. Facial trauma. Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine, Concepts and Clinical Practice. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006. Vol 1: 382-98/chap 39.

  8. Snell RS, Smith MS. The face, scalp, and mouth. Clinical Anatomy for Emergency Medicine. Mosby-Year Book; 1993. 206-241.

  9. Cheung CA, Rogers-Martel M, Golas L, Chepurny A, Martel JB, Martel JR. Hospital-based ocular emergencies: epidemiology, treatment, and visual outcomes. Am J Emerg Med. 2014 Mar. 32(3):221-4. [Medline].

  10. Glynn SM, Asarnow JR, Asarnow R, et al. The development of acute post-traumatic stress disorder after orofacial injury: a prospective study in a large urban hospital. J Oral Maxillofac Surg. 2003 Jul. 61(7):785-92. [Medline].

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Left orbital floor fracture. This patient presented with little motility disturbance; however, because of the large defect in the orbital floor, late enophthalmos was predicted. Surgical repair was undertaken. Note the pneumo-orbitum.
 
 
 
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