![]() The term ‘ blow out fracture’ has historically meant a fracture of the orbital floor secondary to a direct blow to the globe, causing an increase in pressure that results in the thin orbital floor fracturing. Types of Injuries Orbital Floor and Medial Orbital Wall Fractures Ensure the eyelids can close fully and lubricate the cornea. A cold compress and raising the head of the bed can help alleviate periorbital oedema. Patients should be advised not to blow their noses and to sneeze with their mouths open. The aim of initial management in the ED is to prevent further damage to the globe. A CT may already be appropriate due to a mechanism of injury or red flags for a head injury. Investigation of orbital fractures is by x-ray and CT, with CT being the modality of choice, though it can be unreliable in children with blowout fractures. Disruption to the infraorbital nerve: numbness of the ipsilateral cheek, lip, and upper gum.Abnormalities of the nasal bridge (saddle nose deformity) and widening of the midface (telecanthus).Palpation of the orbital rim for tenderness or step.General inspection – oedema, laceration, and bruising.Have a systematic approach to examination so as to ensure all important aspects are covered. Connections between the sensory afferent fibres of the ophthalmic division of the trigeminal nerve and the visceral motor nucleus of the vagus nerve cause bradycardia and hypotension, often with headache, nausea, and vomiting. Initial trauma assessment is always done by the ATLS ABC approach, followed by a detailed secondary survey.Ĭhildren are prone to a pronounced oculocardiac reflex which may become apparent in the initial ABC assessment this is caused by compression of the globe or traction on the extra-ocular muscles. Mechanism of injury is always important to elicit in trauma and careful and thorough (and documented) examination.
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