Injuries (Orbital trauma)

Orbital trauma is a general term used to describe injuries to the bones surrounding the eye (orbit), the tissues surrounding the eye or the eye itself. The following injuries can be categorised as orbital trauma:

> Orbital foreign body
> Orbital penetrating injury
> Blow-out fracture
> Traumatic optic neuropathy

Orbital foreign body

Something in your eye?

Sometimes foreign objects such as metal, dust, wood and others can hit and become embedded in the eye or orbit. If your symptoms and the circumstances in which they arose are suggestive of a foreign body your ocular plastic surgeon will ask a number of questions to try to determine the type and size of the object, as well as its speed and angle at impact.

What is it? Where is it?

The surgeon will thoroughly examine the eye looking for any damage to the eye or surrounding tissues. If there is a possibility that the foreign object is deep within the eye, X-rays or a CT scan may be needed to determine its location. A CT scan will also show whether there are associated fractures and if the object has penetrated into any deeper structures, such as the brain. If the foreign body is wooden it may not be seen on X-ray or CT, and an MRI scan may be necessary.

Treatment

These tests are all necessary to determine whether the foreign body should be surgically removed. Following removal of the foreign body, antibiotics will be prescribed to avoid any infection.

Orbital penetrating injuries

What is an orbital penetrating injury?

A penetrating eye injury means an object has pierced the tissues surrounding the eye or the eye itself.

How can you tell if the eye has been penetrated?

When a facial injury involves the eye area and causes significant skin trauma, penetrating injuries to the eyelid, eye, eye muscle, bone or even the brain may not be immediately obvious. A complete eye examination is necessary to exclude injury to these structures. If the object has penetrated into the area of the brain, a neurological examination may also be necessary.

What treatment will be necessary?

Once the extent of the damage has been determined, the ocular plastic surgeon will concentrate on surgically repairing the damaged tissues.

Orbital blow-out fractures

What is a "blow-out" fracture?

The bony, pear-shaped socket that surrounds and protects the eye is called the orbit. When an object larger than the size of the orbital entrance hits the eye but doesn't penetrate, the force can literally cause a "blow out" of part of the orbit. The bone that forms the floor of the orbit is particularly prone to this type of fracture, known as a blow-out fracture. Blow-out fractures often occur when a fist or ball, or the dashboard of a car during a motor vehicle accident, strikes the eye.

A possible complication of orbital floor fracture is that the eye may partially drop down into the maxillary sinus, which is directly beneath the orbital floor, trapping some of the muscles that move the eye.

Diagnosing orbital blow-out fracture

Warning signs of orbital blow-out fracture include bruising around the eye, double vision, protrusion of the eye and/or numbness in the cheek and upper teeth areas. The ocular plastic surgeon will examine the eye carefully whether it has been damaged. A CT scan will also be performed to assess the extent of the fracture.

Treatment of orbital blow-out fracture

Based on the complete evaluation, your ocular plastic surgeon may recommend surgery. Factors influencing the timing of surgery include persistence of double vision, enophthalmos (the eye appears shrunken in the orbit as the swelling subsides), any limitation of eye movements and the size of the fracture.

Traumatic optic neuropathy

What is traumatic optic neuropathy?

The optic nerve runs from the back of the eye to the brain, where images from the eye are processed and interpreted. Some people who sustain a head injury damage their optic nerve. This can be due to fractures of the bony canal that the nerve runs through, or from swelling or damage to the blood vessels supplying the optic nerve. Traumatic optic neuropathy causes loss of vision in the affected eye.

How is it diagnosed?

Loss of vision is usually instantaneous. A full eye examination is performed to assure no damage has occurred to the eye itself, as well as a CT scan or MRI scan to assess the optic nerve and nerve canal.

Can traumatic optic neuropathy be treated?

Treatment may consist of:

• Intravenous steroids (cortisone drugs) to decrease the inflammation of the nerve
• Surgery to correct any fractures

All people with this condition will be closely monitored in hospital.