Collisions that shouldn’t happen – orbital fractures

With the improvement of living standards, people pay more and more attention to sports and leisure. At the same time, the number of people who are inadvertently injured during sports is increasing. An inadvertent hit to the eye socket by a ball, or by another person’s elbow …… can result in a fracture of the orbital wall of the eye. The current incidence has increased dramatically. Once this happens, it should not be taken lightly. It may be an inadvertent collision that fractures the orbit. Orbital wall fractures include simple orbital wall fractures caused by boxing, projectile impact, etc., mainly manifesting as diplopia, eye entropion, nose bleeding, facial sensory abnormalities, etc.; they also include compound orbital wall fractures caused by serious car accidents, etc., which mostly manifest as not only orbital fractures, but also combined with frontal bone fractures, nasal bone fractures, and zygomatic bone fractures. In contrast, simple orbital wall fractures are often overlooked because of the mild nature of the symptoms. And why do orbital wall fractures occur? Because the human orbit approximates a semi-confined space enclosed by thin bone walls, the normal orbit has four walls and the orbital rim is thick, and fractures do not normally occur. The lower and inner walls of the orbit, however, are as thin as paper. External impact can easily cause fractures in these two thin walls. The weak part of the bone wall is especially susceptible to fracture when subjected to a strong impact from the front of the eye that is larger than the area of the orbital opening. However, this is also a form of self-protection, as the orbital wall fracture indirectly protects the eye itself from damage and preserves vision. There is also a lot of fat behind the orbit, and the fat is like a sofa cushion. When an external force hits the eye, the eye recedes to the back and acts as a cushion, but the bone wall can suddenly burst under sudden pressure. After orbital fracture, generally speaking, in the early stage of injury, due to congestion, edema, pressure and displacement of muscles, nerves and other tissues, discomfort manifestations such as eyelid swelling, diplopia, limited eye movement, nosebleeds, and abnormal sensation of some nerves in the orbit and face will occur. In particular, diplopia, or double vision, can cause difficulty for patients in reading and going down stairs. Some patients may also experience numbness and dullness of sensation in the cheek, nose, upper lip and gums, all of which may affect the patient’s life and work. If the orbital fracture is not treated in a timely manner, the patient may experience orbital collapse and sunken eyes due to increased orbital cavity volume, tissue adhesions, and scar formation in the later stages of the injury, which can seriously affect the appearance. However, after 2-3 weeks of injury, when the tissue congestion and edema have subsided, the orbital cavity volume will increase and the sunken eye will become more and more obvious. It is generally believed that fracture repair can be performed 2 to 3 weeks after the orbital edema subsides; surgical correction of orbital entropion can achieve satisfactory results. The main purpose of surgery is to reset the embedded and herniated soft tissues, repair the orbital wall defect with an intraorbital implant, and reposition the trapped eyeball. The implant material we use is an imported high-density polyethylene that can be trimmed and shaped with scissors and blades to fit the size and shape of the orbital wall and orbital rim defect, and is implanted to completely cover the orbital wall defect. The implant is secured with titanium nails and plates. Postoperative intravenous antibiotics and glucocorticoids for 3 to 5 d, combined with oculomotor exercises, can promote functional recovery.