6.3  Orbital Injuries

6.3  Orbital Injuries

6.3.1  Orbital Soft-Tissue Injuries

In 40–70% of craniofacial traumas, there are additional orbital injuries [Hardt and Sgier 1991 (47%); Kramp et al. 1997 (72%)].

Orbital soft-tissue injuries (Jabaley et al. 1975; Flick 1976; Ioannides et al. 1988; Dutton and Al-Qurainy 1991; Brandes et al. 1997; Kramp et al. 1997; Brown et al. 1999; Poon et al. 1999; Rohrbach et al. 2000) in midface traumas include:

6.3.1.1  Minor Eye Injury

Subconjunctival hemorrhage, hyposphagma, ecchymosis, corneal-injuries.

6.3.1.2  Nonperforating Injury of the Globe

Contusion/distorsion of the globe, iridodialysis, lens luxation, retinal detachment and edema of the optical nerve sheath (Fig. 6.25).

6.3.1.3  Perforating Injury of the Globe (2%)

Perforation, rupture or loss of the globe (Fig. 6.26).

6.3.1.4  Traumatic Neuropathy [Posttraumatic

Optic Neuropathy (PTON)]

In direct frontal orbital contusions, the compression wave is concentrated in the orbital apex. The nervous structures cannot evade the blow and are damaged by the pressure and consequent edema, resulting in optic neuropathy (Rochels and Behrendt 1996; Ernst et al. 2004).

The frequency of such traumatic neuropathies (PTON) in facial skeletal injuries is quoted to be 3.6% (Joseph et al. 1990; Dutton and Al-Qurainy 1991) (Fig. 6.27).

Fig. 6.25  Edema of optical nerve sheath (arrow) after orbital roof fracture and contusion of the globe

6.3.2  Orbital Wall Fractures

In order of frequency, orbital wall fractures occur particularly in combination with the following fracture complexes (Paskert et al. 1988; Fonseca and Walker 1991; Manson 1998; Manolidis et al. 2002):

•Zygomatico-orbital fractures

•Naso-orbito-ethmoid fractures

•Complex upper midface fractures

6.3.2.1  Fracture Frequency

Orbital wall fractures are found in 9.2% of all craniocerebral/frontobasal fractures and in 30–55% of all midface fractures (Neubauer 1987; Holt and Holt 1983; Fonseca and Walker 1991).