Orbital injuries

The causes causing damage to the orbit are diverse: impact by a heavy object, bruise on falling, the introduction of foreign bodies and others. The wounded items can be knives, forks, pencils, ski poles, branches, shot or bullets with a gunshot wound. Isolated orbital damage is relatively rare. More often there are combinations of trauma with damage to the eyeball and its adnexa, as well as combined lesions with brain trauma or damage to the paranasal sinuses. Therefore, when examining a patient, one should pay attention to brain symptoms (loss of consciousness, retrograde amnesia, vomiting, etc.). In the survey, sometimes the participation of a neurosurgeon, dentist, and otolaryngologist is necessary.

Thus, all traumas of the orbit are divided into obtuse: direct (impact directly into the orbit region); indirect (cracks and fractures that spread from other bones of the skull) and gunshot.

Classification of orbital injuries:

• non-firearms account for 79%; firearms - 21%;
• contusions and injuries (usually with damage to the soft tissues of the orbit, sometimes the eyeball);
• open and closed damage;
• damage to the orbit can be accompanied by the introduction of a foreign body.

The severity of damage to the orbit is determined by:

• by the degree of bone wall damage;
• on the position of bone fragments;
• by hemorrhage into orbit;
• on the introduction of foreign bodies;
• on concomitant damage to the eye;
• on damage to the brain substance, paranasal sinuses.

Since ophthalmic injuries are often combined with damage to the eyeball and adjacent parts of the facial skeleton, their diagnosis includes a comprehensive examination of the victim by examination, palpation, careful probing and radiography of the orbital region. It is necessary that the radiographs in two projections capture not only the orbit, but the entire skull. Obligatory are: examination of eyesight, examination of the eyeball, examination of the paranasal sinuses of the nasal cavity and oral cavity, as well as neurological status.

Orbital injuries are relatively easy to recognize due to the presence of wounds of soft tissues, due to visible damage to the integrity of her bones, the severity of damage to the eyeball. But it must be borne in mind that traumas of the bone walls of the orbit can sometimes be masked by edematous soft tissues. Therefore, the appearance and size of the inlet may not correspond at all to the actual nature of the eye socket damage, to mask its severity.

When the orbit is injured, it is always important to establish the direction of the wound channel, since it basically determines the severity of damage to the walls of the orbit, its contents and adjacent organs.

Sagittal (and sagittal-oblique) direction of the wound canal is usually accompanied by brain damage, sometimes quite deep.

The transverse (and transversely-oblique) direction of the canal is often accompanied by damage to one or even both eyeballs, optic nerves, latticular sinuses and frontal lobes of the brain.

With the vertical (and vertically-oblique) direction of the wound channel, as a rule, the frontal and maxillary sinuses, the brain, the base of the skull, and sometimes the cervical part of the spine are damaged. The damage to the sinuses of the nose may be indicated by the emphysema of the orbit and eyelids. If air enters the orbit, exophthalmos appears, in the case of its subcutaneous localization, palpation of the eyelids determines crepitation. Exoptalm also occurs with retrobulbar hemorrhage, oedematous edema.

It is extremely important to determine immediately whether the bone walls of the orbit are damaged or the wound is localized in the volume of its soft contents. In favor of a fracture of the bones of the orbit, the deformation of its edges and walls, the data of X-ray diffraction are indicated. The volume of the orbit can vary with the displacement of bone fragments. If they shift to the inside, the eyeball protrudes, a traumatic exophthalmos appears. When the fragments of the eye socket diverges, the eyeball falls, a traumatic endophthalmus arises. Determined crepitus in the injury of the frontal sinus, there may be damage to the brain substance.

In case of severe injuries, the bone fragments of the optic nerve and interruption can occur, while the victim loses sight, up to complete blindness. Consequences of fracture of orbital bones - traumatic osteomyelitis, pulsating exophthalmos (after combined injuries of the orbit and skull), formed anastomoses near the internal carotid artery and cavernous sinus.

In injuries to the orbit, out-eye muscles are often damaged, as a result of this, the patient develops a double vision.

The syndrome of the upper glottis slit is complete ophthalmoplagia (external and internal, ptosis, complete immobility of the eye, the pupil is enlarged, does not respond to light).

If the warbler receives wooden foreign bodies, pus is secreted from the wound, secondary outbreaks of inflammation are noted.

Metal foreign bodies - they must be urgently removed, if they are large, cause pain, fall in vision, give a reaction to surrounding tissues.

In the early period after the injury of the orbit, the victims can seek emergency help because of severe pain, the presence of an open wound, swelling, hemorrhage, bleeding, deformity of bones, the appearance of exophthalmos or enophthalmos, sudden disorders of visual functions. All such wounded are to be referred to a hospital. Evacuation should be preceded by the introduction of tetanus antitetanus and the imposition of a binocular bandage. In the hospital, urgent surgical care may be needed in the presence of heavy bleeding. In such cases, the skin wound is widened, a bleeding vessel is found and a ligature is applied to it. Gels in the wound foreign body and bone fragments, they are removed, excised fragments of non-viable tissues, hemispheres the bone edges. All this is done with reliable infiltration anesthesia. After surgical treatment, the wound is sprinkled with an antibiotic, a wound is applied to the wound. If there is extensive combined damage to the orbit and adjacent areas, then anesthesia is used.

Combined wounds of the orbit and adjacent organs (skull, brain, face and jaw, nose and paranasal sinuses) - for the surgical treatment attract relevant specialists. After the operation, the patient is prescribed antibiotics, bed rest.

In late terms, after the injury, the victim applies for medical care in cases where the foreign body or bone fragment lying there causes severe pain or vision loss due to pressure on the nerves, or inflammation develops. In such cases, the foreign body or bone fragment is removed. The urgency of such an intervention is determined by the patient's condition.

After the injury of the orbit, inflammation of the orbital fiber may develop even in the long term. The patient complains of sharp pains in the eye area and in the head, puffing out the eyeball. The general condition of the patient is severe, high body temperature, swelling, severe hyperemia and density of the eyelids, inability to open eyes; presence of exophthalmos. In such a state, the patient must be urgently hospitalized.

[1], [2], [3], [4], [5]