eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Orbital: Follow-up

Author: Thomas Widell, MD, Vice Chairman, Assistant Professor, Department of Emergency Medicine, Rosalind Franklin School of Medicine/The Chicago Medical School, North Chicago, Illinois; Associate Residency Director, University of Chicago Emergency Medicine Program, Chicago, Illinois; Program Director Emergency Medical Education, Attending Physician, Mount Sinai Hospital Medical Center, Chicago, Illinois
Contributor Information and Disclosures

Updated: Mar 6, 2008

Follow-up

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.

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.

Transfer

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

Deterrence/Prevention

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

Complications

  • 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

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 excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education article, Facial Fracture.
  • Patients should be informed of the high risk of posttraumatic stress disorder and should be referred to a psychiatrist should symptoms occur.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose orbital fracture
  • Failure to diagnose associated intracranial or cervical spine injuries
  • Failure to diagnose an eye injury secondary to poor patient cooperation, extensive edema, or lack of familiarity with eye exam

Special Concerns

  • Always consider and check for loss of airway, intraabdominal injury, and intracranial injury.
  • Consult an ophthalmologist in the ED if the patient has experienced loss of vision or significant decrease in visual acuity or signs of entrapment, retinal detachment, hemorrhage, or retrobulbar swelling.
 


More on Fracture, Orbital

Overview: Fracture, Orbital
Differential Diagnoses & Workup: Fracture, Orbital
Treatment & Medication: Fracture, Orbital
Follow-up: Fracture, Orbital
References
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References

  1. 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. Jul 2003;61(7):785-92. [Medline].

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

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

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

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

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

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

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

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

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Further Reading

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Keywords

blow-out fractures, fractures of the orbit, maxillary fracture, superior orbital rim fracture, frontal bone fracture, high-impact orbital injuries, tripod fractures, zygomaticomaxillary complex fractures, orbital fractures, eye injury

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Contributor Information and Disclosures

Author

Thomas Widell, MD, Vice Chairman, Assistant Professor, Department of Emergency Medicine, Rosalind Franklin School of Medicine/The Chicago Medical School, North Chicago, Illinois; Associate Residency Director, University of Chicago Emergency Medicine Program, Chicago, Illinois; Program Director Emergency Medical Education, Attending Physician, Mount Sinai Hospital Medical Center, Chicago, Illinois
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric Legome, MD, Residency Director, Assistant Professor of Emergency Medicine, Department of Emergency Medicine New York University, New York University Hospital, Bellevue Hospital Center, Manhattan VA
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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