With the development of transportation and industry, there are more opportunities for traumatic injuries such as traffic accidents, falls from height, boxing injuries and falls, and consequently, the incidence of orbital fractures due to orbital trauma has increased. Orbital fractures are characterized by early swelling of the eyelid, subcutaneous hemorrhage and pain, which may resolve on their own after treatment or a few days. Typical symptoms of entropion or diplopia usually appear after a week. If the fracture is small, these symptoms may not be obvious. What is an orbital fracture? The orbit is located in the middle of the face, with the superior orbital rim protruding forward and weak orbital wall bones except for the orbital rim. Because of these anatomical factors, orbital fractures are prone to occur under a strong external blow to the middle of the face or skull. Orbital fractures are serious orbital trauma and can be classified as orbital floor fractures, orbital rim fractures, orbital roof fractures, and fractures of the medial and lateral orbital walls according to the fracture site. Orbital fractures can also occur simultaneously with other maxillofacial fractures, such as zygomatic fractures, frontal fractures or maxillary and type III fractures. When the middle of the face is fractured by external impact, the orbital floor is impacted and the intraorbital pressure increases dramatically, which can cause orbital floor fracture, which is also called orbital burst fracture. Since the maxillary sinus is below the orbit, orbital floor fracture often herniates the orbital contents into the maxillary sinus. What are the clinical manifestations of orbital fracture? I. Periorbital petechial hemorrhage, swelling, and protrusion of the eye: In the early post-injury period, periorbital subcutaneous and subconjunctival hemorrhage is caused by early intraorbital hemorrhage, edema of the extraocular muscles, intraorbital fat, and inflammatory reaction. It improves after the absorption of hemorrhage and edema or appears as an intraocular sink. Second, rhinorrhea: fracture of the intraorbital wall can cause mucosal injury of the septal sinus, causing once there is rhinorrhea to be alert to the possibility of fracture of the intraorbital wall. Intraocular invagination: In severe traumatic injuries with a large fracture area and more soft tissue embedded in the maxillary sinus or septal sinus, intraocular invagination occurs immediately after the injury. However, most of them appear about 10 days after the injury. In mild cases, the eye sinks 2-3 mm, while in severe cases, the eye sinks 5-6 mm and the lid fissure becomes smaller. The causes of orbital invagination: soft tissue embedded in the sinus through the fracture fissure makes the orbital content shrink; the volume of the orbital cavity is enlarged due to the fracture; 3. Intraorbital fat undergoes degeneration, atrophy, resorption, and scar formation due to inflammatory reaction after trauma, resulting in a reduction in the volume of the orbital content. Displacement of the eye: The lower part of the orbital fat, the suspensory ligament of the eye, the inferior rectus muscle and the inferior oblique muscle herniated into the maxillary sinus, resulting in the lower displacement of the eye. V. Intraorbital air accumulation: After trauma, the patient’s nose bleeds and the nasal gas pressure increases when blowing the nose or sneezing, and the air enters the subperiosteum or orbit through the fracture fissure and diffuses into the orbital soft tissues and eyelid soft tissues, manifesting as eyelid swelling and twisting pronation when touched. VI. Diplopia and ocular motility disorders: The causes of diplopia are edema of the extraocular muscles after trauma, inadequate function of the extraocular muscles, paralysis of the motor nerves innervating the muscles, adhesions and embedding of the muscles at the fracture margin. All these factors affect the movement of the eye and cause eye movement disorders. Once the muscle is embedded or adhered, surgical release is required to eliminate the limiting factors. VII. Infraorbital nerve hyperalgesia or loss of perception: most of the inferior wall fractures are located in the infraorbital nerve sulcus, and damage to the infraorbital nerve can cause sensory impairment in the innervated area. This can be manifested as numbness and hyperalgesia or loss of sensation in the cheek, upper lip, upper gingiva, and other areas. VIII. Cerebrospinal fluid leakage: the fracture of the orbital wall is superior, the horizontal plate is damaged, and there is cerebrospinal fluid leakage appears. Does orbital fracture require surgical treatment? If the fracture is small in extent, the inversion of the eye is not obvious (not more than 2mm), does not affect the appearance, or there is no limitation of eye movement and no binocular diplopia, no surgical treatment is required. If the fracture is large, if the eye sink is obvious and affects the appearance, or if there is limitation of eye movement and no recovery of binocular diplopia, surgery is required. What is the timing of surgical treatment for orbital fracture? If the orbital fracture requires surgical treatment, it should be done promptly. If it is too early to operate, the swelling of the injured area will not disappear, while if it is too late, the injury will be dislocated and healed or scarred, making it difficult to achieve satisfactory results. Orbital fractures in children, especially orbital floor fractures, should be operated as early as possible, and the earlier the operation, the better the repair effect. The earlier the surgery is performed, the better the result will be. Late surgery will often result in degeneration and atrophy of the extraocular muscles due to embolism, which will affect future eye movements and may lead to lifelong regrets. What is the purpose of orbital fracture surgery? The purpose of surgery is to reset the embedded extraocular muscle and fat, implant artificial bone fragments or substitutes in the orbital wall fracture defect area, restore orbital cavity volume and eye movement, and improve eye entropion and diplopia. Do I need functional training after orbital fracture surgery? After orbital fracture surgery, in order to prevent re-adhesion of the extraocular muscles to the surrounding tissues and to promote functional recovery of the orbital muscles, patients can be helped to perform motor training of the extraocular muscles. Specific method: 48 hours after orbital fracture surgery, open the bandage and suspend an eye-catching target object, about 5 cm in diameter, from the ceiling, with the patient lying on his back and the target object about 1.5 cm from his head, and let the target object make a pendulum movement, and the patient’s gaze will follow the movement of the target object to achieve the effect of eye movement, 3 times a day, with 100 eye movements each time. Adherence to the training, which is very important for the ultimate success of the surgery.