The orbit plays a protective role for the eye, and orbital fractures can occur when the orbit or periorbital bones are struck by an external force. Orbital fractures are one of the common types of craniomaxillofacial injuries and can occur alone or in combination with other craniofacial fractures. Surgical anatomy The orbit is the bony cavity that houses the eye and is approximately quadrangular and conical in shape, with the tip of the orbit at the top of the cone. The orbit consists of 7 bones, including the maxillary zygoma and the sieve bone. The orbital floor is composed mainly of the maxilla, zygoma, and palatine bones. The intraorbital wall consists of the maxilla, lacrimal bone, sieve bone, and pterygoid bone in order from anterior to posterior, with the main structure being the extremely thin (0.2-0.4 mm) sieve bone cardboard. The anatomy of the intraorbital wall is the most complex. The orbital floor and the intraorbital wall are the most frequently involved sites for fractures. Fracture classification Simple orbital: orbital rim is intact and only the orbital wall is fractured; non-simple orbital fracture: combined fracture of the orbital rim and orbital wall, mostly orbital fractures combined with fractures of the zygomatic complex, nasal orbital sieve, and frontal bone. Causes of fractures Simple orbital fractures are mainly due to boxing injuries or falls, while most non-simple orbital fractures are due to traffic injuries. In addition to examining the orbital fracture for functional and cosmetic deficits caused by the orbital fracture, a basic ophthalmologic examination should be performed, including visual acuity, eye movements, pupillary reflexes, visual fields, and fundus examination. 1. Medical history Ask the patient or other witnesses about the nature, size, and direction of the injurious force and whether there is a history of post-injury coma. The diagnosis can be made by combining clinical examination and imaging examination. Clinical manifestations (1) The acute phase of fracture may include intraorbital hemorrhage, periorbital edema, periorbital petechiae, subconjunctival hemorrhage, and subcutaneous emphysema. (2) Intraocular deformity fractures often cause enlargement of the orbital cavity and downward and backward displacement of the eye. In the early stage, it may not be obvious or the eyeball may protrude, but after 5 to 7 days, the swelling subsides and the intraocular sunkenness becomes visible. (3) Ocular motility disorders can be caused by displacement of the extraocular muscles by pulling or entrapment. (4) Diplopia can be produced by subluxation/inversion of the eye, extraocular muscle injury, and oculomotor nerve injury. (5) Early visual impairment is usually caused by corneal trauma, penetrating eye injury, optic nerve canal fracture, optic nerve contusion, or retinopathy. The later stage can be caused by glaucoma, corneal leukoma, cataract and optic nerve atrophy. (6) Periorbital numbness is mostly caused by injury to the infraorbital or supraorbital nerve. (3) Imaging (1) Plain radiographs of Fahrenheit can show the orbital apex and orbital floor. Indirect signs of fracture, such as teardrop-like manifestations or air-fluid planes, can be observed through this film position. Plain films do not show fractures of the orbital wall well and cannot localize foreign bodies. (2) The combination of CT axial and coronal and 3D reconstructed CT images can clarify the specifics of orbital rim and orbital wall fractures and soft tissue injuries, select surgical indications, and guide the development of surgical plans. (3) MRIMRI can be used to assess soft tissue injury in orbital trauma. Treatment of fractures If clinical examination and CT examination reveal the presence of risk factors for entropion and diplopia, surgery should be performed as early as possible. Traumatic diplopia may occur early in the fracture. If CT examination does not reveal soft tissue and extraocular muscle entrapment and the extraocular muscle pull test is negative, no special treatment is required. If diplopia is evident, eye movement is limited, the extraocular muscle pull test is positive, and the CT examination reveals an embedded extraocular muscle and its surrounding tissues, prompt surgical treatment is required. In the case of simple orbital floor or orbital wall fractures, the area of orbital wall fracture is carefully explored through a sublid margin incision or lid conjunctival incision and a pars plana incision, respectively, and the orbital contents embedded in the maxillary and septal sinuses are returned, followed by adequate exposure of the edges of the orbital wall defect area, especially the posterior border, and repair with autologous bone or bone substitute lining. The normal orbital floor protrudes into the orbit in an arched shape behind the ball. This structure is difficult to restore and can be compensated by filling with implants. Postoperative considerations Postoperative antibiotics are recommended for 3 days. Antibiotics may be penicillins, cephalosporin antibiotics or clindamycin. Postoperatively, hormones may be applied for about 3 days depending on the periorbital and orbital content edema. Timely examination and recording of visual acuity. Postoperative CT examination is performed to clarify the effect of orbital wall reconstruction. Postoperative review is recommended at 3 months.