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Orbital Trauma / Suspected Orbital Fracture

Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2021

Overview

The bones around the eye often take the force of an impact to the orbit. If there is a suspicion of a fracture to the bones of the orbit, facial X-rays can be taken, however these frequently miss fractures. A CT of the orbit is the definitive way to diagnose orbital fractures

Who to refer

If an orbital fracture is suspected please discuss the case with maxillofacial surgeons and the on-call ophthalmologist. Instruct the patient not to blow their nose.

Red Flag

See factors to access below.

Before referral

Factors to assess in these cases are:

  • Heart rate and BP (an extraocular muscle caught in a fracture can cause significant bradycardia)
  • Visual acuity
  • Eye movements, ask about diplopia and look for restriction in eye movements
  • Assess the eye for signs of an open eye injury (as above) and retrobulbar haemorrhage (as below)
  • Skin sensation above and below the orbit.

This will help triage the urgency of referral when discussing with secondary care.

Referral

Discuss with maxillofacial surgeons an the BEH on-call opthalmologist.

Resources

These guidelines have been written by Rhys Harrison, consultant ophthalmologist at Bristol Eye Hospital, with thanks to the patients who have kindly given consent to use their photos.

For full ophthalmology guidelines see: Primary Care Ophthalmology Guidance Document



Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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