I. What is orbital fracture? The orbit is located in the center of the face and protrudes forward, making it susceptible to fractures from external forces. An orbital fracture is a fracture or displacement of the craniomaxillofacial bones that surround the eye and form the orbit under the action of an external force. There are many important structures in the orbit, such as the eyeball, optic nerve, extraocular muscles and other vascular nerves, which depend on the protection of the orbit and are vulnerable to damage during orbital fracture. Why is it necessary to examine the orbit after trauma to exclude orbital fracture? 1. Orbital fracture can cause local pain Bleeding patients can have intraorbital hemorrhage, periorbital soft tissue edema, periorbital petechiae, subconjunctival hemorrhage, subcutaneous emphysema and rhinorrhea due to orbital fracture injury to the nasal mucosa, intraorbital and periorbital soft tissues, resulting in vascular rupture and bleeding. 2, orbital fracture can cause visual impairment Patients are mostly caused by corneal trauma, penetrating eye injury, intraocular hemorrhage, crystal dislocation, optic nerve canal fracture, optic nerve contusion or retinal injury in the early stage. Later stages can be caused by glaucoma, corneal leukomalacia, cataract and optic nerve atrophy. Vision loss due to optic nerve canal fracture is often very serious, even blindness. 3. Orbital fractures can cause inversion and displacement of the eyeball. When an orbital fracture occurs, the patient often exhibits pseudohyperopthalmia due to the lack of support for the eyelid as a result of orbital invagination. In compound orbital fractures, due to the large orbital wall defect and the displacement of the fractured orbital rim and orbital wall, the sunken and displaced eyeball is even more pronounced, and sometimes the eyeball is not even visible. 4. Orbital fractures can cause eye movement disorders and diplopia. Diplopia is what we usually call “double vision”. The diplopia caused by orbital fracture is mostly caused by soft tissue and extraocular muscle impingement, extraocular muscle injury, eye displacement and motor nerve injury, which is quite complicated to deal with, and it is completely different from the diplopia caused by paralytic strabismus. It can occur immediately after the injury or several months after the injury. 5. Orbital fracture can also cause orbital surface deformity, facial sensory disorder, inner and outer canthus deformity, tear duct rupture, nasolacrimal duct fracture, chronic lacrimal sacculitis, etc. At the same time, compound orbital fracture can remove the eyeball due to severe eye rupture injury, resulting in sunken eye sockets without eyeballs, etc. What are the main tests to rule out orbital fracture after trauma? The diagnosis of orbital fracture is mainly based on the history of trauma, physical examination and imaging examination. Patients with orbital fractures often have a clear history of trauma. Imaging examinations, especially CT examinations, are the “gold standard” for orbital fracture diagnosis, which can not only clearly diagnose orbital fractures, but also determine the fracture site, its extent, and the degree of damage, and provide a very useful reference for clinical treatment. Which orbital fractures can be treated conservatively? 1. Indications for non-surgical treatment (1) Negative retraction test. (2) No intraocular invagination. (3) CT film shows that the fracture does not destroy the orbital structure and there is no intraorbital tissue embedding. If any 1 of these 3 items is present, the patient may not require surgery. (4) If the orbital fracture is combined with penetrating eye injury, central retinal artery embolism and traumatic retinal detachment involving the macula, early orbital surgery is not recommended and orbital surgery should be performed 4-6 months after the trauma to the eye itself. The purpose of rotation training is to make the embedded extra-ocular muscles and soft tissues gradually detach from the fracture suture, usually after the local edema has subsided for 1 week. There are two methods as follows: (1) forced eye rotation training: that is, under anesthesia of eye performance, the upper edge of the cornea is clamped with toothed forceps to do upward or downward forced rotation once every other day for about 10 minutes. (2) Automatic eye rotation training: the patient can recover from upward gaze and abduction dozens of times a day. V. Which orbital fractures require surgery? Early surgical treatment of orbital fractures mainly refers to surgical treatment within 3 weeks after the trauma. All compound orbital fractures require early surgical treatment as long as the patient’s general condition permits. The goals of early surgical treatment of orbital fractures are to eliminate and improve functional diplopia, prevent and correct intraocular invagination, repair and reconstruct the shape of the orbit, and correct and improve orbital deformities. Early surgical treatment has many advantages: (1) early surgery allows early release of embedded or trapped soft tissues (fat, extraocular muscles, ligaments), avoiding or greatly reducing the occurrence of ischemia, fibrous scar formation, and necrotic atrophy of related tissues; (2) early surgery for compound orbital fractures allows easy repositioning and fixation of displaced fracture blocks, with good surgical results; (3) early surgery decompresses the infraorbital nerve and (4) Early orbital floor exploration allows timely treatment of false-negative cases in clinical examination; (5) Early surgery achieves better results in both functional and cosmetic aspects with fewer complications, avoiding late surgery with poorer results.