Orbital Trauma
Eye Plastic Specialists are ophthalmologists who specialize in orbital trauma. Orbital trauma includes injuries to the orbit (pear-shaped bones surrounding the eye) or to the tissues surrounding the eye. The following orbital trauma categories are addressed in this section:
1. Orbital Foreign Body
2. Orbital Penetrating Injuries
3. Blow-out Fractures, and
4. Traumatic Optic Neuropathy (Injury to the Optic Nerve)
ORBITAL FOREIGN BODY
If the history suggests a possible orbital foreign body, your eye plastic surgeon will obtain an in-depth history focusing on the type and size of the object, as well as the speed and angle of the foreign body at impact. You can assist this evaluation by bringing in any additional foreign body of the same type such as BB"s or pellets.
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Eye Trauma from BB pellet:
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| A complete ocular examination will be undertaken by your eye plastic surgeon to assure that no damage has occurred to the eye or surrounding tissues. Often, dental films of the eyeball or orbit may locate a foreign body. A CT scan is very helpful in not only evaluating the presence of the foreign body, but also in assessing possible associated bony fractures or intracranial involvement. An MRI scan may be the study of choice if a wooden foreign body is suspected. |
| CT scan showing orbital foreign body (BB pellet): |
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Based on the history, ocular examination and radiological study, your ophthalmologist will determine whether surgical removal of the foreign body is recommended. Removal of the orbital foreign body, if required, will occur in the operating room setting. Post-operatively, your medication regimen will include an antibiotic ointment to the wound area and antibiotics by mouth.
ORBITAL PENETRATING INJURIES
Penetrating injuries of the orbital region by sharp objects may result in insignificant skin trauma masking injuries to deeper tissues, such as the eyelid, eye, eye muscle, bone, or even the brain. A complete ocular examination by your eye plastic surgeon is necessary to exclude injury to the eye or surrounding tissues. A neurosurgical consultation will be necessary if the object has penetrated into the area of the brain.
Further evaluation may include a CT scan to assess the orbital bones and tissues which surround the eye and also to localize possible orbital foreign bodies. After confirming a normal examination of the eye and surrounding orbital tissue and bone, your eye plastic surgeon will focus on the surgical repair of the damaged tissues.
ORBITAL BLOW-OUT FRACTURES
The eye is protected by a pear-shaped bony orbit. The bony floor of the orbit is particularly susceptible to a type of fracture called a "blow-out" fracture. The force of a non-penetrating object greater in size than the orbital entrance can result in a "blow-out fracture." Typically, these types of fractures are caused when the orbit is struck by a ball, fist, or a dashboard during a motor vehicle accident.
You may notice bruising around the eye, double vision (diplopia), protrusion of the eye (proptosis) and/or numbness in the cheek and upper teeth areas. Your eye plastic surgeon will perform a complete ocular examination to assure that no damage has occurred to the eye. This exam may include a test where the eye is rotated to assess whether the eye muscles are involved in the fracture site. A radiological study, such as a CT scan, will be performed to assess the extent of the fracture. Your eye plastic surgeon may request that you limit pressure on the fractured site by avoiding blowing your nose and by limiting physical activity.
Based upon this complete evaluation, your eye plastic surgeon may recommend surgical correction of the "blow-out" fracture either initially or within the next few weeks. Factors that will influence this decision include persistence of double vision, enophthalmos (eye appears shrunken in the orbit as swelling subsides), involvement of eye muscles and the size of the fracture. Your eye plastic surgeon will determine if surgery is necessary in your individual case to achieve satisfying cosmetic and functional results.
TRAUMATIC OPTIC NEUROPATHY
Craniofacial Trauma (head & face) may result in injury to the optic nerve, the nerve that connects the eye to the brain. This type of injury is present in less than 5% of closed head trauma cases. Injury can occur not only from fractures in the bony canal around the optic nerve, but also from swelling or damage to the blood vessels supplying the optic nerve.
Visual loss usually occurs instantaneously, but delayed visual loss is possible. Your eye plastic surgeon will perform a complete ocular examiantion to assure that no damage has occurred to the eye. A radiological study, such as a CT scan or MRI scan, will be performed to assess the optic nerve and optic canal.
Based on this information, your eye plastic surgeon will recommend one of the following treatments: (1) Intravenous steroids, or (2) Surgical intervention to correct fractures in the bony canal surrounding the optic nerve. Your eye plastic surgeon will monitor you closely in the hospital for your response to the selected treatment. Eye plastic surgeons around the country are currently participating in a collaborative study to determine the most appropriate treatment for patients with traumatic optic neuropathy.
