The fragile tissues of the eyelids and orbit are often damaged in patients of facial trauma. A cautious examination is initially necessary to ensure that the eye itself is not involved and to establish the extent of the injuries.
In addition, the lacrimal system may also be injured in patients who experience lid trauma. Finally, the orbit itself may be involved. Patients may experience penetrating orbital trauma, orbital fractures, and even orbital foreign bodies.
An oculoplastics specialist is uniquely trained to manage this delicate region as any of these periocular injuries is a potential threat to the vision.
Oculoplastic surgeon Dr. Jennifer Hui provides advanced solutions for various eye ailments to patients in Palm Springs, Palm Desert, La Quinta, Coachella Valley, Riverside, Redlands, Yucaipa, Loma Linda, and surrounding communities.
Management of Ocular or Orbital Injury
Suggestions for the treatment of orbital and ocular injuries:
Ocular injuries, specifically, may be quite severe and lead to stress for the providers involved along with the patient and family.
A majority of patients with any type of facial fractures, such as orbital, will experience moderate to severe pain. This pain needs to be managed due to the presence of a relatively high density of pain fibers in the facial and orbital areas, which make the pain symptoms significant.
While orbital fractures can be apparent, they are often subtle and can be difficult to diagnose. If a fracture is suspected, it is a good idea to order a CT scan to determine whether orbital trauma exists.
A robust general examination is an initial step in caring for a patient who arrives with an obvious eye injury. After more serious injuries have been addressed or ruled out, the doctor may consider the assessment and treatment of ocular trauma.
There should be a systematic evaluation of visual acuity, diagnosis of soft tissue injuries, observation of epiphora, assessment of muscle function and globe position, and palpation for bony deformities.
A corneal abrasion is very common in orbital trauma, and patients can be very uncomfortable making pain control especially crucial.
If there is a possible orbital floor injury, it is vital that the patient avoids or takes significant care with nose blowing to ensure that the nasal bacteria are not passed upward into the orbit.
Antibiotics will be necessary if the orbital injury is related, in any manner, to the nasal or sinus cavity.
Once the primary trauma assessment to rule out life-threatening injuries has been undertaken, the doctor will focus on any injury that might threaten the patient’s eye function or vision. This would necessitate a rapid consultation with an ophthalmologist.
Retrobulbar hemorrhage is an example of such injuries. In this condition, bleeding behind the globe is an emergent problem, as the pressure in the eye socket can become excessively high hindering any blood supply to the retina. This may result in retinal ischemia and blindness.
Any apparent globe injury, such as lens dislocation, hyphema, or open globe
Extraocular muscle entrapment from orbital floor fracture in a child is indicated by the inability to move the eye in upward gaze, or at times, downward gaze. The doctor may also observe autonomic instability, the oculocardiac reflex.
Patients who are under ten years of age may require emergent surgery to release the muscle from the fracture and prevent acute hemodynamic instability and long-term ocular motility issues.