Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Orbital fractures

Mark I Neuman, MD, MPH
Richard G Bachur, MD
Section Editors
Susan B Torrey, MD
Evelyn A Paysse, MD
Maria E Moreira, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic will review the evaluation and management of patients with orbital fractures, mechanisms of injury to the orbit, fracture types, and associated injuries.

Other facial fractures in adults and children are discussed separately:

(See "Initial evaluation and management of facial trauma in adults".)

(See "Nasal trauma and fractures in children".)

(See "Jaw fractures in children".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 15, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Manolidis S, Weeks BH, Kirby M, et al. Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions. J Craniofac Surg 2002; 13:726.
  2. Hatton MP, Watkins LM, Rubin PA. Orbital fractures in children. Ophthal Plast Reconstr Surg 2001; 17:174.
  3. Neuman MI, Eriksson E. Facial trauma. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher G, Henretig R (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.1475.
  4. Cruz AA, Eichenberger GC. Epidemiology and management of orbital fractures. Curr Opin Ophthalmol 2004; 15:416.
  5. Koltai PJ, Amjad I, Meyer D, Feustel PJ. Orbital fractures in children. Arch Otolaryngol Head Neck Surg 1995; 121:1375.
  6. Donahue DJ, Smith K, Church E, Chadduck WM. Intracranial neurological injuries associated with orbital fracture. Pediatr Neurosurg 1997; 26:261.
  7. Kreidl KO, Kim DY, Mansour SE. Prevalence of significant intraocular sequelae in blunt orbital trauma. Am J Emerg Med 2003; 21:525.
  8. Umeed S, Shafquat S. Commotio-retinae and central retinal artery occlusion after blunt ocular trauma. Eye (Lond) 2004; 18:333.
  9. Chen X, Yao Y, Wang F, et al. A retrospective study of eyeball rupture in patients with or without orbital fracture. Medicine (Baltimore) 2017; 96:e7109.
  10. Segrest DR, Dortzbach RK. Medial orbital wall fractures: complications and management. Ophthal Plast Reconstr Surg 1989; 5:75.
  11. Ahmad F, Kirkpatrick NA, Lyne J, et al. Buckling and hydraulic mechanisms in orbital blowout fractures: fact or fiction? J Craniofac Surg 2006; 17:438.
  12. Jatla KK, Enzenauer RW. Orbital fractures: a review of current literature. Curr Surg 2004; 61:25.
  13. Smith B, Lisman RD, Simonton J, Della Rocca R. Volkmann's contracture of the extraocular muscles following blowout fracture. Plast Reconstr Surg 1984; 74:200.
  14. Lisman RD, Smith BC, Rodgers R. Volkmann's ischemic contractures and blowout fractures. Adv Ophthalmic Plast Reconstr Surg 1987; 7:117.
  15. Long J, Tann T. Orbital trauma. Ophthalmol Clin North Am 2002; 15:249.
  16. Brady SM, McMann MA, Mazzoli RA, et al. The diagnosis and management of orbital blowout fractures: update 2001. Am J Emerg Med 2001; 19:147.
  17. Kim YS, Kim JH, Hwang K. The Frequency of Decreased Visual Acuity in Orbital Fractures. J Craniofac Surg 2015; 26:1581.
  18. Alhamdani F, Durham J, Greenwood M, Corbett I. Diplopia and ocular motility in orbital blow-out fractures: 10-year retrospective study. J Craniomaxillofac Surg 2015; 43:1010.
  19. Su Y, Shen Q, Lin M, Fan X. Diplopia of pediatric orbital blowout fractures: a retrospective study of 83 patients classified by age groups. Medicine (Baltimore) 2015; 94:e477.
  20. Cohen SM, Garrett CG. Pediatric orbital floor fractures: nausea/vomiting as signs of entrapment. Otolaryngol Head Neck Surg 2003; 129:43.
  21. Egbert JE, May K, Kersten RC, Kulwin DR. Pediatric orbital floor fracture : direct extraocular muscle involvement. Ophthalmology 2000; 107:1875.
  22. Burnstine MA. Clinical recommendations for repair of orbital facial fractures. Curr Opin Ophthalmol 2003; 14:236.
  23. Bansagi ZC, Meyer DR. Internal orbital fractures in the pediatric age group: characterization and management. Ophthalmology 2000; 107:829.
  24. Vasudev S, Reddy KS. Trigemino-cardiac reflex during orbital floor reconstruction: a case report and review. J Maxillofac Oral Surg 2015; 14:32.
  25. Richards NQ, Brown NH, Kidwell ED Jr. Visual Acuity in Orbital Floor Fractures: Does Surgical Subspecialty Management Matter? J Craniofac Surg 2015; 26:1668.
  26. Otori N, Haruna S, Moriyama H. Endoscopic endonasal or transmaxillary repair of orbital floor fracture: a study of 88 patients treated in our department. Acta Otolaryngol 2003; 123:718.
  27. Matteini C, Renzi G, Becelli R, et al. Surgical timing in orbital fracture treatment: experience with 108 consecutive cases. J Craniofac Surg 2004; 15:145.
  28. Hollier LH, Thornton J, Pazmino P, Stal S. The management of orbitozygomatic fractures. Plast Reconstr Surg 2003; 111:2386.
  29. Chung SY, Langer PD. Pediatric orbital blowout fractures. Curr Opin Ophthalmol 2017; 28:470.
  30. Becelli R, Renzi G, Mannino G, et al. Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures. J Craniofac Surg 2004; 15:29.
  31. Courtney DJ, Thomas S, Whitfield PH. Isolated orbital blowout fractures: survey and review. Br J Oral Maxillofac Surg 2000; 38:496.
  32. Martin B, Ghosh A. Antibiotics in orbital floor fractures. Emerg Med J 2003; 20:66.
  33. Mundinger GS, Borsuk DE, Okhah Z, et al. Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice. Craniomaxillofac Trauma Reconstr 2015; 8:64.
  34. Millman AL, Della Rocca RC, Spector S, et al. Steroids and orbital blowout fractures--a new systematic concept in medical management and surgical decision-making. Adv Ophthalmic Plast Reconstr Surg 1987; 6:291.
  35. Flood TR, McManners J, el-Attar A, Moos KF. Randomized prospective study of the influence of steroids on postoperative eye-opening after exploration of the orbital floor. Br J Oral Maxillofac Surg 1999; 37:312.
  36. Damgaard OE, Larsen CG, Felding UA, et al. Surgical Timing of the Orbital "Blowout" Fracture: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2016; 155:387.
  37. Yamanaka Y, Watanabe A, Sotozono C, Kinoshita S. Impact of surgical timing of postoperative ocular motility in orbital blowout fractures. Br J Ophthalmol 2017.