Orbital fractures are often diagnosed on imaging tests like X-rays and CTs. Orbital fractures occur as a result of direct blunt trauma to the eye. Fractures can be complicated and result in vision loss, reduced eye movement, nerve damage, bleeding and entrapped tissue. An eye surgeon or ophthalmologist will direct the care of these fractures.
What is an orbital fracture?
The orbit or eye socket contains the eye ball, nerves, blood vessels, and fat. The orbit has a thick bony rim and a thinner floor and inside wall. The floor and inner wall are more likely to break than the rim.
The fracture can be minor involving a small part of the orbit or extensive and involving other facial bones. There can be complications like entrapped tissues at the fracture site, injury to the eye ball, double vision, abnormal position of the eye ball, nerve injury and bleeding.
Symptoms of orbital fracture
There may be be pain, bruising, swelling, double vision and numbness of the face.
How is orbital fracture diagnosed?
Orbital fractures are best evaluated with CT. CT scans can diagnose the fracture and any complications.
Complications can include entrapped tissues like the muscles around the eye. This can cause difficulties with moving the eye.
CT can identify other facial fractures or injuries to the brain. Bleeding around and behind the eye can be identified.
What does an orbital fracture look like on imaging?
An orbital fracture is best assessed with CT scans. There will be a break or discontinuity in the bone of the orbit. We can also see where exactly the fracture is and how extensive it is. We can see any complications.
X-rays can also diagnose orbital fractures but are not as good at detecting fractures. We will not see complications like entrapped tissues in the fracture or bleeding.
Ultrasound and nuclear medicine do not have a place in primary diagnosis.
MRI may be used to image the orbit in rare cases following orbital fractures, but is not used for primary diagnosis.
What else can look like orbital fracture in radiology?
There is usually no confusion in diagnosing orbital fractures in the setting of injury or trauma to the eye.
There are sutures around the eye socket where bones come together that can sometimes look like a fracture. Usually these are found on both sides and do not look like a break in the bone.
What causes orbital fractures?
Usually an injury or direct trauma to the eye socket. This can be something like a punch to the eye socket or baseball directly hitting the eye.
Is an orbital fracture dangerous?
It can be because there can be injury to the eye ball or the surrounding structures like the muscles. There can also be additional facial fractures and injuries in the brain. There can be dangerous bleeding behind the eye ball which needs treatment.
What type of doctor treats orbital fracture?
An ophthalmologist or eye surgeon treats these injuries.
Orbital fracture treatment
Treatment may be non surgical when the fracture is small or does not impair function or vision. In these cases, the fracture may be allowed to heal on its own.
More extensive fractures or those that cause vision problems, trouble moving the eye or abnormal position in the eye socket may need surgery.
Orbital fracture: summary
Orbital fractures occur after a direct blow to the eye. Fractures more commonly involve the floor and inner wall since they are the thinnest. Orbital fractures are diagnosed most commonly with CT scan. We can also see other injuries and complications with CT. Treatment is directed by an eye surgeon. He will determine if surgery is indicated.