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Orbital injuries

 
, medical expert
Last reviewed: 07.07.2025
 
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The causes of orbital damage are varied: a blow with a heavy object, a bruise from a fall, the introduction of foreign bodies, etc. The objects causing injury may be knives, forks, pencils, ski poles, branches, pellets, or bullets from a gunshot wound. Isolated orbital damage is relatively rare. More common are combinations of trauma with damage to the eyeball and its adnexa, as well as combined lesions with brain injury or damage to the paranasal sinuses. Therefore, when examining a patient, it is necessary to pay attention to cerebral symptoms (loss of consciousness, retrograde amnesia, vomiting, etc.). The examination sometimes requires the participation of a neurosurgeon, dentist, or otolaryngologist.

Thus, all orbital injuries are divided into blunt: direct (a blow directly to the orbital area); indirect (cracks and fractures spreading from other bones of the skull) and gunshot.

Classification of orbital injuries:

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

The severity of orbital damage is determined by:

  • according to the degree of damage to the bone walls;
  • by the position of bone fragments;
  • by hemorrhage into the orbit;
  • on the introduction of foreign bodies;
  • for associated eye damage;
  • due to damage to the brain tissue and paranasal sinuses.

Since orbital 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 inspection, palpation, gentle probing and radiography of the orbital region. It is necessary that the radiographs in two projections cover not only the orbit, but also the entire skull. The following are mandatory: vision testing, examination of the eyeball, examination of the paranasal sinuses and oral cavity, as well as neurological status.

Orbital injuries are relatively easy to recognize by the presence of soft tissue wounds, visible damage to the integrity of its bones, and the severity of the damage to the eyeball. But it should be borne in mind that injuries to the bone walls of the orbit can sometimes be masked by edematous soft tissues. Therefore, the type and size of the entrance hole may not correspond at all to the actual nature of the damage to the eye socket, masking its severity.

When an orbital injury occurs, it is always important to establish the direction of the wound channel, since it mainly determines the severity of damage to the orbital walls, its contents and adjacent organs.

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

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

With a 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 spine are damaged. Emphysema of the orbit and eyelids may indicate damage to the sinuses. If air gets into the orbit, exophthalmos appears; in the case of its subcutaneous localization, crepitus is detected during palpation of the eyelids. Exophthalmos also occurs with retrobulbar hemorrhage, edema of the orbital tissue.

It is extremely important to immediately determine whether the orbital bone walls are damaged or whether the injury is localized in the volume of its soft contents. Deformation of its edges and walls, X-ray data speak in favor of a fracture of the orbital bones. The volume of the orbit can change when the bone fragments are displaced. If they are displaced inward, the eyeball protrudes, and traumatic exophthalmos occurs. When the orbital fragments diverge, the eyeball sinks, and traumatic endophthalmos occurs. Crepitus is determined when the frontal sinus is damaged, there may be damage to the brain matter.

In severe cases of injury, compression of the optic nerve by bone fragments and interruption may occur, with the victim losing vision, even going completely blind. Consequences of orbital bone fractures include traumatic osteomyelitis, pulsating exophthalmos (after combined injuries to the orbit and skull), and fistulas forming near the internal carotid artery and cavernous sinus.

When the orbit is injured, extraocular muscles are often damaged, causing the patient to experience double vision.

Superior orbital fissure syndrome - complete ophthalmoplagia (external and internal; ptosis, complete immobility of the eye, pupil dilated, does not react to light).

If wooden foreign bodies get into the vorbit, pus is released from the wound, and secondary outbreaks of inflammation are observed.

Metallic foreign bodies - they must be removed immediately if they are large, cause pain, loss of vision, or cause a reaction in surrounding tissues.

In the early stages after orbital injury, victims may seek emergency care due to severe pain, an open wound, swelling, hemorrhage, bleeding, bone deformation, exophthalmos or enophthalmos, and sudden visual impairment. All such victims should be sent to a hospital. Evacuation should be preceded by the administration of antitetanus serum and the application of a binocular bandage. In a hospital, emergency surgical care may be needed if there is profuse bleeding. In such cases, the skin wound is widened, the bleeding vessel is found and a ligature is applied to it. If there are foreign bodies and bone fragments in the wound, they are removed, scraps of non-viable tissue are excised, and the bone edges are sutured. All this is performed under reliable infiltration anesthesia. After surgical treatment of the wound, it is sprinkled with an antibiotic, and a mine is applied to the wound. If there is extensive combined damage to the orbit and adjacent areas, then anesthesia is used.

Combined injuries of the orbit and adjacent organs (skull, brain, face and jaws, nose and paranasal sinuses) - appropriate specialists are involved for surgical treatment. After the operation, the victim is prescribed antibiotics and bed rest.

In the later stages after the injury, the victim seeks medical help in cases where a foreign body or bone fragment located in the orbit causes severe pain or decreased vision due to pressure on the nerves, or inflammatory phenomena develop. In such cases, the foreign body or bone fragment is removed. The urgency of such intervention is determined by the patient's condition.

After an orbital injury, even at a late stage, inflammation of the orbital tissue may develop. The patient complains of sharp pains in the eye area and in the head, and protrusion of the eyeball. The patient's general condition is severe, with high body temperature, swelling, severe hyperemia and density of the eyelids, inability to open the eyes; exophthalmos. In such a condition, the patient must be urgently hospitalized.

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