Evaluation and management of orbital trauma

Abstract

Orbital injuries occur in a variety of settings, road traffic accidents (RTA) being the commonest. Injuries vary in severity and have potential for visual impairment and disfigurement. Diligent history-taking and careful examination is desirable in all cases. Circumstances of injury and subtle external wounds indicate orbital foreign body. CT scan of the orbits axial and coronal views and thin cuts around the apex of the orbit reveal the nature of injury and help plan management. Traumatic optic neuropathy (TON) and injury to the globe threaten vision. Management of traumatic optic neuropathy is controversial. Systemic steroid is considered harmful. Decompression of the optic nerve offers no benefit. Blow-out fracture of the orbit associated with diplopia and soft tissue entrapment may require surgery and interdisciplinary approach. Orbital compartment syndrome needs immediate reduction of orbital pressure. Type of the intraorbital foreign body, its mechanical effect, and presence of infection guide their management. This article presents an overview of evaluation and management of orbital injuries from the point of view of comprehensive ophthalmologists.