6.3.4  Fracture Signs

6.3.4.1  Clinical Manifestations

Clinical signs of orbital wall fractures are emphysema, orbital hematoma, infraorbital nerve hypesthesia, altered position of the globe, disturbed eye motility, retraction syndrome and changes of the palpebral fissure (Neubauer 1987; Stassen et al. 2003; Dutton and Al Qurainy 1991).

Clinical manifestations in orbital wall fractures

•Change in globe position

•Disturbance of eye motility

•Pseudoptosis

•Orbital emphysema

•Hypesthesia of the infraorbital nerve

•Retraction syndrome

•Change in width of the palpebral fissure

6.3.4.2  Change in Globe Position

The position of the globe is determined by the volume of the orbital fatty tissue, the periocular muscle balance, tissue hydration and tension of the ligaments and septa (Manson et al. 1980).

Factors influencing the globe position

•Volume of periorbital fatty tissue

•Balance of ocular muscle tone

•Ligament integrity

•Atmospheric pressure

•Tissue hydration

Changes in globe position are either due to an increase/ decrease in osseous orbital volume or increase/ decrease in orbital/periorbital soft-tissue volume. An increase in orbital volume/deficit in periorbital tissues results in an enophthalmus, muscular imbalance and disturbed eye motility; a reduction in bony orbital volume/increase in periorbital soft tissue will result in exophthalmus, disturbed motility and change in the globe position (Parsons and Mathog 1988; Stassen et al 2003).

6.3.4.3  Enophthalmus

An anterior-posterior change in the globe position, an enophthalmus is caused by either a fracture-related size increase of the orbital cavity or a reduction in soft-tissue volume (Manson et al. 1986; Stassen et al 2003).

Enophthalmus

Reasons for a relative or absolute increase in orbital volume with changes in the position of the globe (anterior-posterior)

6.3.4.4  Exophthalmus

An exophthalmus results from an inward displacement of bony wall fragments or through a pathological increase in orbital soft-tissue volume.

Exophthalmus

Reasons for a relative or absolute volume reduction with changes in the position of the globe (anteriorposterior)

•Inward dislocation of orbital wall fragments (blow-in fracture)

•Reduction of osseous orbital volume

•Retrobulbar – intraconal hematoma

•Edema – emphysema

•Subperiosteal hematoma

6.3.4.5  Vertical Displacement of the Globe

Vertical changes in the position of the globe are based on either a dislocated orbital floor fracture with antral soft-tissue prolapse or on an orbital roof fracture of the blow-in type.

Reasons for vertical globe displacement