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Orbital Trauma

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Pediatric Ophthalmology in the Emergency Room

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Abstract

The periorbital area is the third most commonly injured region in children with facial fractures. In the setting of midfacial trauma, a complete eye examination is warranted to rule out globe injury; unfortunately, ophthalmic evaluation is often overlooked in the acute trauma setting. After screening for serious ocular injuries, a high index of suspicion must be maintained for the presence of a trapdoor orbital floor fracture that requires urgent surgical exploration and repair. Computed tomography (CT) is the imaging gold standard for the detection of orbital fractures.

In patients with non-trapdoor orbital floor or medial wall fractures, repair is only required to address either disfiguring enophthalmos or persistent diplopia. Repositioning of all herniated tissue and proper implant placement are the key components in the successful surgical repair of orbital wall fractures.

Orbital hemorrhage/compartment syndrome must be suspected in midfacial trauma patients presenting with a decrease in visual acuity, an afferent pupillary defect, subconjunctival hemorrhage, proptosis, and elevated intraocular pressure (IOP). Traumatic orbital foreign bodies can be easily overlooked, especially in asymptomatic patients, and therefore clinicians must be vigilant in reviewing imaging studies and examining for entrance wounds in the appropriate clinical setting.

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  1. Rutgers New Jersey Medical School, The Institute of Ophthalmology and Visual Science, Newark, NJ, USA

    Stella Y. Chung & Paul D. Langer

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  1. Professor of Ophthalmology, Otolaryngology Department of Ophthalmology, Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Roman Shinder

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Chung, S.Y., Langer, P.D. (2021). Orbital Trauma. In: Shinder, R. (eds) Pediatric Ophthalmology in the Emergency Room . Springer, Cham. https://doi.org/10.1007/978-3-030-49950-1_4

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