NON PENETRATING INJURY TO THE EYEBALL
A blow in the orbital region without penetration of a foreign body may lead to an intraorbital haemorrhage (may occur from pressure with forceps at birth)
Injuries to the bone most commonly affect the margin of the orbit → diagnosed from the unevenness of the margin, sensitivity to pressure, and sometimes crepitation
Deeper Fractures may cause Orbital emphysema; presence of gas within the orbital soft tissues. Usually due to orbital fractures communicating with the paranasal sinuses.
Blow-out fractures are usually due to blunt trauma caused by a large object (a ball) → transmitting force into the orbit which is reflected back but as the object blocks the orbital opening the force is directed to the orbital walls → most commonly the orbital floor blows out but can also affect the medial wall → as the orbital floor fractures, the eye and surrounding tissue may collapse into the maxillary sinus causing enophtalmous and entrapment of the inferior rectus muscle
Fractures of the base of the skull may involve one or both optic foramina → in which case the optic nerve may be injured or pulsating exophthalmos is seen. Blindness without ophthalmic signs is seen along with orbital and subconjunctival haemorrhage Clinical Features:
- Pain with local tenderness
- Epistaxis
- Diplopia
- Prominence of eye on blowing his nose
Examination
- Initial oedema
- Ecchymosis
- Emphysema around the ocular adnexa with a restriction of ocular movement commonly upwards or outwards
Complications
- Associated damage to sinuses may cause orbital crepitus
- Infraorbital hypoesthesia may be present because of entrapment of the infraorbital nerve
- After the inflammation, there may be a relative enophtalmous and redistricted ocular motility upwards
- If there is fracture of the orbital floor → traumatic enopthalmous
[Important to diagnose blow-out fractures early to correct the diplopia by inserting a thin layer of silicone rubber between the periosteum and bone of the orbital floor after reducing the herniation of the soft tissues]
Treatment:
If wound is present → should be cleaned
If foreign body is possibly retained → CT scan → removed surgically afterwards Local and systemic antibiotics if indicated