Orbital Fracture in Emergency Medicine Follow-up
- Author: Thomas Widell, MD; Chief Editor: Rick Kulkarni, MD more...
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]
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.[9]
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.[9]
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