00:01
All right, trauma to the orbit
that causes a blowout fracture.
00:06
So most orbital fractures occur,
as indicated in the green box,
in the posterior medial area
where the bones are thinner.
00:13
Most of the rest of the orbit,
lateral, superior, inferior,
relatively thicker bones.
00:19
So, if there's
increased pressure over the eye,
it will tend to blowout
in that medial canthal area.
00:26
So, in the posterior medial area.
00:29
And what is shown on the right,
is just a blowout.
00:33
So you're seeing
fracture of the bone
with associated hemorrhage.
00:37
We haven't really ruptured
the orbit.
00:39
Yes, you can, under extreme
circumstances rupture the orbit,
but that's not what
we're talking about here.
00:45
And that's a
different entity altogether.
00:47
And once that happens,
it's kind of end of the game.
00:51
But we're talking about
bony fractures of the orbit.
00:55
What are the consequences
related to this?
So pain.
Yeah, got that.
00:59
Yeah, broken a bone,
it hurts like crazy.
01:03
There's going to be
associated inflammation,
so there will be edema.
01:07
There will be ecchymosis.
01:08
Yes, you've broken lots, and
lots, and lots of blood vessels,
so there'll be bruising.
01:13
Of course,
you have a big old black eye.
01:15
Depending on the compression
of associated nerves
as the bone fractures,
and the associated hemorrhage
compressing those nerves,
you may have
restricted ocular movement.
01:27
In fact,
we're looking at a child
who had a blowout fracture
of the orbit,
and now can't bring down
his left eye.
01:35
So he has had some impact
on his ocular motor nerve,
which is going to be
running primarily
in that medial posterior area.
01:44
Because of the hemorrhage,
you may have
increased intraocular pressure
that does need to be released.
01:49
Because if you have
increased intraocular pressure
in the same way that
you can have optic atrophy
or optic nerve atrophy
associated say with glaucoma,
increased intraocular pressure,
because of hemorrhage behind the eye
really needs to be addressed
and you need to decompress that.
02:06
And clearly, as a result of the
now, blood,
or other fluids that are
accumulating in various places,
you may have double vision
because the eyes
are not appropriately aligned.
02:18
Other signs and symptoms?
So this is showing
another blowout fracture,
this was one that would have
affected the cranial nerve III,
in fact, could have given
the appearance of the child
that you saw
on the previous image.
02:34
There will be loss of sensitivity
in the area
because there are
infraorbital nerves
that are also
going to be compressed.
02:40
So you may have a relative analgesia
related to that.
02:44
And because
the sinus cavity is right there
and you can drain into the sinuses,
you may have epistaxis
or just literally, a bloody nose.
02:52
That also makes a lot of sense
because of the proximity
of the various structures
around a blowout fracture.
03:00
No surgical treatment of the
fracture is typically indicated
unless there's entrapment
of the extra ocular muscles,
or increased intraocular pressure.
03:08
So, we will let the bone heal
unless we have these
other problems going on.
03:16
And with that, we've talked about
trauma to the eye,
cornea, and to the orbit.