RT Book, Section
A1 Stark, Christopher L.
A2 Knoop, Kevin J.
A2 Stack, Lawrence B.
A2 Storrow, Alan B.
A2 Thurman, R. Jason
SR Print(0)
ID 1181488648
T1 Orbital Wall Fractures
T2 The Atlas of Emergency Medicine, 5e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260134940
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181488648
RD 2024/04/24
AB Orbital  floor  fractures  are  produced  by  two  distinct  mechanisms.  The  1st  is  a  true  “blowout”  fracture  where  all  the  energy  is  transmitted  from  a  blunt  object  to  the  globe,  causing  increased  orbital  pressure  blowing  out  either  the  orbital  floor  (most  frequently)  or  medial  wall.  Fists  and  balls  are  the  most  common  causative  agents.  This  mechanism  of  injury  is  more  likely  to  cause  entrapment  and  globe  injury.  The  2nd  mechanism  of  injury  occurs  when  the  energy  from  the  blow  is  transmitted  to  the  infraorbital  rim,  causing  a  buckling  of  the  orbital  floor.  Patients  with  blowout  fractures  have  periorbital  ecchymosis  and  lid  edema  but  may  also  sustain  globe  injuries,  including  chemosis,  subconjunctival  hemorrhage,  or  infraorbital  numbness  from  injury  to  the  infraorbital  nerve.  Other  globe  injuries  seen  with  orbital  wall  fractures  include  corneal  abrasion,  hyphema,  enophthalmos,  proptosis,  iridoplegia,  dislocated  lens,  retinal  tear,  retinal  detachment,  and  ruptured  globe.  Diplopia  with  upward  gaze  suggests  entrapment  of  the  inferior  rectus  or  its  supporting  structures.  Diplopia  with  lateral  gaze  suggests  entrapment  of  the  medical  rectus  muscle.  Periorbital  subcutaneous  emphysema  is  frequently  seen  with  orbital  wall  fractures  because  of  the  proximity  to  the  sinuses.