Diplopia on upward gaze is often seen in fractures of the inferior wall due to entrapment of inferior rectus, inferior oblique.Proptosis – Seen in retrobulbar hematoma.Enophthalmos – Early finding which precedes tissue edema.Tear drop pupil should raise concern for globe rupture.Visual acuity is the most important measure of eye function.Every patient should have a complete eye exam including visual acuity, pupillary exam, slit lamp exam with fluorescein, ocular pressure testing.1/3 of orbital wall fractures have concomitant ocular trauma (Kreidl, Kim, & Mansour, 2003).Patients with suspected retrobulbar hematoma should be monitored on telemetry until pressure is relieved.More common in children, but also in adults.Results in bradycardia, nausea, and syncope asystole is rare complication.Oculo-cardiac Reflex: Stretch receptors in ophthalmic nerve are activated in response to pressure in the ocular and periorbital soft tissue leading to stimulation of a vagal response (Dunville & Kramer, 2018).Significant force applied to the nasal bridge can result in naso-orbito-ethmoid fractures that are often accompanied by injury to the lacrimal duct, dural tears, and traumatic brain injury.Fractures of other portions of the orbit and fractures of the orbital ridge result from high energy impacts and are frequently associated with other fractures or injuries.Intraorbital contents herniate through fracture, then fracture returns to original position causing entrapment. ![]() More common in children due to soft bone.Associated with higher risk of ocular injury compared to Impure fractures.Occurs when small object strikes globe directly, without causing orbital ridge or rim fracture.Force is transmitted through globe and results in fracture of the fragile inferior or medial orbital walls.Any fracture of inferior or medial walls.
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