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Orbital fractures

INTRODUCTION

Although orbital fractures are rarely life-threatening, they may be associated with serious intracranial and ocular injuries that require emergent management. In addition, injuries affecting vision and those with cosmetic implications must be promptly recognized and referred for appropriate treatment.

This topic will review the evaluation and management of patients with orbital fractures. Mechanisms of injury to the orbit, fracture types, and associated injuries are also discussed here. A rapid overview of essential considerations is provided (table 1).

EPIDEMIOLOGY

Prevalence and mechanism — Orbital fractures occur more commonly among young adult and adolescent males. In a retrospective series describing 92 adults with orbital fractures, the mean age was 32 years, and 72 percent were male [1]. A retrospective series describing orbital fractures in children reported a mean age of 12.5 years [2]. Of these children, 81 percent were boys.

The low prevalence of orbital fractures among younger children may be related to the following:

  • The face of a child is relatively small compared with the head, and thus most fractures in young children tend to involve the upper face and skull [3].
  • In children, the proportion of cancellous to cortical bone is greater, providing more elasticity to the facial bones. In addition, sinus cavities are poorly developed. However, pneumatization of the frontal sinus may actually be protective for adults with injury to the superior orbital rim. (See 'Orbital roof fracture' below.)
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