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orbital fracture (blowout fracture)
Etiology:
- direct trauma to the orbit
Pathology:
1) entrapment of inferior rectus muscle results in restricted elevation of eye
2) enopthalmus when orbital contents displaced into maxillary sinus
3) edema generally resolves in 7-10 days
Clinical manifestations:
1) diplopia, especially upward or downward gaze
2) gaze palsy, inability to look upward
3) numbness in distribution of ipsilateral maxillary nerve may be present
4) subconjunctival hemorrhage
5) periorbital edema
6) ipsilateral nose bleed
4) symptoms may resolve with resolution of edema in 7-10 days
Radiology:
- CT of orbit
- CT of skull base
Differential diagnosis:
- eye injury
Management:
1) assess extraocular muscle motility [3]
2) observation for 7-10 days prior to surgery, unless otherwise indicated
3) intranasal decongestants
4) avoid blowing nose
5) antibiotics for sinusitis frequently given
Related
eye injury/trauma
Specific
orbital floor fracture; blowout fracture
orbital fracture, other than floor (blowout fracture)
General
skull fracture (cranial fracture)
References
- UpToDate 14.1
http://www.utdol.com
- Medical Knowledge Self Assessment Program (MKSAP) 15,
American College of Physicians, Philadelphia 2009
- NEJM Knowledge+ Ophthalmology