Impact of orbital fracture on the eye

09/07/2024

The orbit is a complex bony structure that houses and protects the eye and its essential components, including muscles, nerves and blood vessels. Orbital fractures can have serious repercussions on ocular health, affecting both visual function and aesthetic appearance. Timely diagnosis and treatment are essential to minimize long-term consequences.

Repercussions on the eye

Orbital fractures can cause various eye problems, depending on the severity and location of the injury.

• Double vision (diplopia): This is one of the most common complications after an orbital fracture. It occurs, for example, when the eye muscles are trapped or displaced, preventing proper alignment. An orbital floor fracture can trap the inferior rectus muscle, limiting eye movement and causing double vision.
• Enophthalmos: This the posterior displacement of the eyeball within the orbit, resulting in a sunken appearance of the eye. It may occur due to loss of bone support or displacement of soft tissues into the maxillary sinus through an orbital floor fracture.
• Hematomas and hemorrhages: Orbital fractures can cause periorbital hematomas (bruising around the eye) and subconjunctival hemorrhages (bleeding under the conjunctiva). Although these usually resolve over time, they may indicate significant trauma and require medical attention.
• Nerve damage: The infraorbital nerve, which provides sensation to the cheek, upper lip, and lower eyelid, can be damaged in an orbital fracture, resulting in numbness or paresthesia. In specific cases, the optic nerve may be at risk, threatening vision in the affected eye.
• Limitation of ocular mobility: Orbital fractures can restrict the movement of the affected eye, either due to muscle entrapment or other changes in the orbital contents. This not only causes diplopia, but can also limit the patient's visual field.
• Infection: If the fracture communicates with the paranasal sinuses, there is a risk of developing orbital infections, such as orbital cellulitis, which require immediate treatment to prevent complications.
• Cosmetic problems: In addition to functional complications, orbital fractures can cause cosmetic deformities, such as facial asymmetry and visible scarring. These issues can affect the patient's self-esteem and quality of life, making reconstructive intervention necessary.

Diagnosis of orbital fractures generally includes physical examination to evaluate evaluationf ocular mobility, vision, and appearance of the orbit. Diagnostic tests such as computed tomography are also used to evaluate the extent of the fracture and detect any bone displacement or muscle entrapment.

Treatment depends on the severity of the injury and the symptoms presented. An evaluation and surgery, if necessary, should be performed by a specialized oculoplastic surgeon. Conservative treatment with rest, ice application, analgesics and close monitoring is suitable for minor fractures without muscle entrapment or notable ocular subsidence. However, surgery may be required for cases with persistent double vision, significant enophthalmos, muscle entrapment, bone displacement, or to correct aesthetic deformities. Surgery may involve releasing trapped muscles and reconstructing the orbital wall with synthetic materials.

Recovery can range from weeks to months, and ongoing follow-up with an ophthalmologist is essential to monitor recovery and treat any complications. Rehabilitation may include vision therapy to treat diplopia and specific exercises to improve eye mobility.

Thus, orbital fractures can have serious repercussions on ocular health, affecting both visual function and aesthetic appearance. Early diagnosis and proper treatment are crucial to minimize complications and promote a full recovery. Specialized care and close follow-up are essential to ensure the best possible quality of life for affected patients.

Dr. Rob Van der Veen, ophthalmologist at the Barraquer Ophthalmology Centre