An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall caused by blunt force impact larger than the eye socket. Key anatomical structures like nerves, blood vessels and extraocular muscles are at risk. Clinical signs may include double vision, sunken eye, numbness. Diagnosis involves examination of eye movements and vision, along with CT scan showing herniated orbital contents. Treatment depends on severity but may include antibiotics, steroids, or surgical repair using titanium mesh to support the orbit. Complications can include persistent double vision or an unusually sunken eye.

1. Orbital blowout
fracture.

2. An orbital blowout fracture is a traumatic
deformity of the orbital floor or medial wall,
typically resulting from impact of a blunt
object larger than the orbital aperture, or eye
socket.
Etiology:

3. Anatomical
considerations:
3-Optic nerve foramen
III = Oculomotor nerve (Motor)
IV = Trochlear nerve (Motor)
VI = Abducens nerve
V1 = Ophthalmic (Sensory)
1-Superior orbital fissure
2-Inferior orbital fissure
V2 = Infra-orbital nerve.
II = Optic nerve.
Intra-orbital neurovascular structures.
1
2
3

4. Fronta
l
Sphenoi
d
Zygomatic
Maxillary
Ethmoid Lacrimal
Anatomical
considerations:
The medial
wall is
slightly
thinner
(0.25 mm vs
0.50 mm) of
floor
thickness

5. Anatomical
considerations:
 Lateral rectus muscle
 Medial rectus muscle
 Superior rectus muscle
 Inferior rectus muscle
 Superior oblique muscle
 Inferior oblique muscle
Ocular muscles:

6. Extra-ocular muscles
Eye movement of lateral rectus muscle,

7. Extra-ocular muscles
Eye movement of superior oblique muscle,

8. II- Optic (vision)
III = Oculomotor nerve (Motor)
double vision (diplopia)
eyelid drooping (ptosis)
pupil dilation (mydriasis)
IV = Trochlear nerve (Motor)”Sup. Obliq. M
double vision (diplopia)
Squint.lateral sup
VI = Abducens nerve.
double vision (diplopia)”Lat. Rec. M
Squint.-medial
V1 = Ophthalmic (Sensory)
Corneal anesthesia.
V2 = Infra-Orbital (Sensory)
Skin of lower eye lid-nose-upper lip.
Clinical significance of intra-orbital structures:

9. Orbital trauma:
 Edema or hematoma within the internal
orbit.
 Orbital blowout fracture.
Clinical significance of intra-orbital structures:
Increase the intra-orbital
pressure, compromising
the intra-orbital
neurovascular
structures.

10. Signs and symptoms:
 Loss of sensation due to infraorbital nerve injury
 Diplopia and enophthalmos.
 Orbital pain
 Limitation of eye movement.
 Orbital and lid subcutaneous ecchymosis or
emphysema.
Diagnosis:

11. Diagnosis:
Clinical examination:
Ocular motility:
Test eye movements in all possible directions.
Presence of squint or improper eye movement
denoting muscle entrapment or neural damage.
Forced duction test used for differentiation.

12. Pupil function:
Pupillary light reflex provides a useful
diagnostic tool for testing the integrity of the
sensory (CN II) and motor (CN III) functions
of the eye.
 Direct reflex.
 Consensual reflex
Diagnosis:
Clinical examination:

13. Diagnosis:
Imaging:
Plain radiographs do not
sensitively capture blowout fractures.
C.T: (coronal cut) teardrop sign, polypoid mass
consists of herniated orbital contents, periorbital fat
and inferior rectus muscle.
The affected sinus is partially
opacified on radiograph. Air-fluid
level in maxillary sinus due to
presence of blood.

14. Diagnosis:
Imaging:
Medial wall fracture is less common
than floor fracture due to presence
of honey comb ethmoid bone.

15. Inflammatory myopathy
Vitreous
hemorrhage
Diagnosis:
Imaging:
MRI : Detection of
 Inflammatory myopathy
 Optic nerve condition
 Vitrous hemorrhage.
Optic nerve
damage

16.  All patients should follow-up with
an ophthalmologist within one week of
the fracture (Retinal examination,
Intra-ocular pressure).
 To prevent orbital emphysema, patients
 are advised to avoid blowing of the nose.
 Nasal decongestants are commonly used. It is also
common practice to administer prophylactic antibiotics
when the fracture enters a sinus.(Amoxicillin-clavulanate
and azithromycin)
 Corticosteroids are used to decrease swelling.
 Surgical repair of a "blowout" is safely postponed for up to
two weeks, if necessary, to let the swelling subside.
Pre-operative preparation:

17. Surgery is indicated if there is :
Enophthalmos greater than 2 mm.
Double vision on primary or inferior gaze.
Entrapment of extraocular muscles.
Fracture involves greater than 50% of the orbital floor.
Most blowout fractures heal spontaneously without significant
consequence.
Surgical management
It can be safely postponed for up to two weeks

18. Reconstruction is
usually performed
through a
Transconjunctival
incision.
Surgical management
Transconjunctival

19. Reconstruction
through a
Subciliary incision.
Surgical management

20. Reconstruction is usually performed
with Titanium mesh or porous
polyethylene or polydioxanone .
Surgical management
polydioxanone
polyethylene

21. Complications:
More recently, there has been success
with endoscopic, or minimally invasive,
approaches.
partial relief from double vision or a
sunken eye.
Ectropion of lower eye lid.
Graft morbidity.
Sunken eye
Ectropion
Graft