orbital-fractures- ANIMATION

Stages for Orbital Fractures Mgmt

2 3 4

Post op & Complications Prognosis
Rehab Care
.

1

Per op &
Immediate
post op Care

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Stages for Orbital Fractures Mgmt

2 3 4 5

Post op & Complications Prognosis Patient
Rehab Care Education
.
.

1

Per op &
Immediate
post op Care

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1.Per op procedures-

a) Surgeon role- the patient's visual acuity, extraocular motor
function, diplopia, degree of enophthalmos and dysesthesia should be documented.
During surgery, the function of the pupil must be serially assessed.

b) Anesthesiologist- should be told to avoid medications that cause pupillary
constriction or dilatation.
When manipulating the extraocular muscles, the anesthesiologist should be warned about
bradycardia secondary to the oculo cardiac reflex.

2.Immediate post op Care

The surgeon should evaluate the patient's vision in the recovery room postoperatively
as soon as the patient is alert enough to cooperate.
The vision after surgery should be essentially the same as preoperative vision, and no
afferent pupil should be present (assuming no afferent pupil was present preoperatively).

The surgeon should inspect for signs of excessive retrobulbar haemorrhage, such as
proptosis or increased intraocular pressure.

Patients should be seen the next day in the office and evaluated for vision, pupils,
motility, and intraocular pressure.

3. Postoperative and Rehabilitation Care

During postoperative care, the examiner should watch out for

a) postoperative complications such as
infection, visual, or central nervous system (CNS) symptoms.

b) The patient's head should be elevated to reduce the oedema and
cool compresses can be placed over the closed eyelid to reduce pain and swelling.

c) The patient's visual acuity and pupillary function should be periodically assessed.

d) Inpatient & Outpatient Medications
▪ Start patients on a combination steroid/antibiotic ointment on the wound 4 times per day

and have them follow up in 1 week.

▪ A broad-spectrum antibiotic is used postoperatively

▪ in elderly or immune-compromised patients along with analgesics of choice.

COMPLICATIONS

 EARLY COMPLICATIONS :

1. Hemorrhagic or orbital hematoma – treated by
-lateral cathotomy immediately, lateral canthal Tendon lysis.

Lateral canthotomy -indicated when –
- Decreased visual acuity
- Introcular pressure more than 40mmHg
- Proptosis
- Opthalmoplegia

2.Retrobulbar hemorrhage

- Rare, rapidly progressive life
threatening emergency that
results in accumulation of blood
in the retrobulbar space

- Increased IOP → stretching of
the optic nerve & blockage of
ocular perfusion

- Proptosis , marked
subconjuctival ecchymosis
& edema ,

 Symptoms seen are – pain, decreasing visual acuity,
Diplopia

Treatment includes
 iv mannitol – (used to treat raised intracranial

pressure)
 Acteazolamide – carbonic anhydrase inhibitor ;

diuresis in PCT of kidney – excretion of NA, K, Cl –
lowering BP, IOP
 Mega dose Steroid Therapy – 100mg Dexa as an
i.v. bolus with 40mg 6 hourly in severe unresponsive
cases ( Anderson et al 1982)

3. Blindness

OCULOCARDIAC REFLEX/ TRIGEMINO CARDIAC/ TRIGEMINO VAGAL REFLEX

 CLINICAL FEATURES –
- Bradycardia
- Faintness
- Further stimulation can

lead to cardiac dysrhythmias
- Atrioventricular blocks
- Asystole

- Bradycardia has been
- attributed to Trigeminal
- derived vagal reflex

LATE COMPLICATIONS

 Altered vision

 Diplopia

 Ectropion – lower eyelid turns outward

 Epiphora – overflow of tears onto the face –
insufficient tear film drainage from eye in that
tears will drain down the face rather than through
nasolacrimal system

 Enopthalmous

Prognosis

most patients obtain resolution of Diplopia and correction of Enophthalmos.

Following the repair of a blowout fracture, the outcomes are not always guaranteed and
the recovery is often prolonged.

Some patients may have neuralgia of the infraorbital nerve for 6-9 months.

Others may have diplopia, which may require REDO surgery.

Finally, enophthalmos may worsen with time.

Patient Education

01 02 03 04

PHYSICAL ACTIVITY FACE & NOSE NERVE RECOVERY WOUND CARE

avoid strenuous activity Nose blowing should also motor nerve (third nerve patient's visual acuity
Physical activity is limited- 3-6 be avoided for about 4-6 branch) or sensory nerve and pupillary function
weeks after surgery to prevent re- weeks to prevent orbital (infraorbital nerve) can take should be periodically
injury emphysema weeks or months to return to assessed.
normal

Timeline for orbital fracture management

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Timeline for orbital fracture management

01

Presentation

Acute or delayed consultation

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Timeline for orbital fracture management

01 02

Presentation Early Sx intervention

Acute or delayed consultation 3- 5 days.

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Timeline for orbital fracture management

01 03

Presentation 02 Late Sx intervention
10 -14 days.
Acute or delayed consultation Early Sx intervention
3- 5 days.

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Timeline for orbital fracture management

3d reconstruction

Custom implants -3-5 days.

04

01 03

Presentation 02 Late Sx intervention
10 -14 days.
Acute or delayed consultation Early Sx intervention
3- 5 days.

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Timeline for orbital fracture management

Post op period 05

2- 4 weeks.

3d reconstruction

Custom implants -3-5 days.

04

01 03

Presentation 02 Late Sx intervention
10 -14 days.
Acute or delayed consultation Early Sx intervention
3- 5 days.

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Timeline for orbital fracture management

Post op period 05 06

2- 4 weeks. Follow up

3d reconstruction 6-10 weeks

Custom implants -3-5 days.

04

01 03

Presentation 02 Late Sx intervention
10 -14 days.
Acute or delayed consultation Early Sx intervention
3- 5 days.

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