Treatment protocol for broken floor of eye socket

This article is professionally consulted by Master, Doctor Hoang Thanh Nga - Ophthalmologist - Department of Medical Examination and Internal Medicine - Vinmec Ha Long International General Hospital.

The orbit is a pear-shaped bone made up of 7 bones: the maxillary bone, the cheekbone, the frontal bone, the lacrimal bone, the palatine bone, the ethmoid bone, and the sphenoid bone.
The floor of the orbit or the infraorbital wall is made up of the maxillary bone, cheekbones and palatine bone, the floor of the orbit is thin and located above the jawbone.
An orbital floor fracture is a condition in which the orbital floor breaks and collapses into the underlying organization. The orbital floor is the most common site of injury in the walls of the orbit because the bony structure is very thin during trauma.
Consequences of damage to the floor of the orbit are that the eyeball and surrounding structures are lowered, stuck in the fracture socket or herniated into the maxillary sinus, making the eyeball prone to fall into the maxillary sinus, causing deviation of the eyeball axis. , complications affecting the function of the eye socket and the patient's aesthetics.

Signs of an orbital floor fracture:
After trauma, pain, bruising, swelling of the eyelids, difficulty opening the eyes, tearing, possibly bleeding around the eye may occur. Eyes may be sunken. Eye movement disorder, difficulty or inability to move eyes in some directions. Effects on vision: Decrease or loss of vision on the affected side, double vision. After the injury, if there are abnormal signs, it is necessary to check, for early detection and early treatment.

Principles of treatment when there is trauma to the floor of the eye socket:
It is necessary to detect and treat early, to avoid the risk of sequelae affecting eye function and aesthetics for the patient. Combined treatment of combined injuries. Especially life-threatening injuries. According to research, early intervention should be within 2 weeks after the injury, to avoid the phenomenon of tissue fibrosis. However, during this time, there is still tissue edema and there may not be any signs in the eyes.

Specific treatment:
Medical
If there is a life-threatening combination injury such as bleeding, traumatic brain injury, it is necessary to immobilize, stop bleeding and monitor vital signs, consciousness, oxygen if necessary. Use anti-inflammatory drugs, relieve pain, reduce tissue edema.

Surgery: In the fracture of the orbital floor causing entrapment of the eyeball and affecting vision requiring surgical treatment, the aim is to release the trapped tissue, hernia, remove the hematoma in the orbit, and reconstruct it. Orbital floor with suitable material.
The previous surgical method often used an incision into the floor of the orbit, which can be through the lower eyelid margin, through the cheek-blepharo fold or the lower eyelid conjunctiva. However, it often leaves bad scars or causes some complications such as late malocclusion, entropion, incorrect reconstruction... Laparoscopic surgery: A recent method widely used in treatment. This method helps to reconstruct the orbital floor through the mouth with the endoscope to help access the eye surgery area accurately, and at the same time ensure aesthetics because it does not leave scars outside the face. During surgery, attention should be paid to: During surgery, attention should be paid to the following components of the orbit, the visual hole... Need to correct and reshape the orbit: The floor of the eye socket is broken, the jaw bone is broken, and the axis of the eye is misaligned. bridge . During surgery, it is necessary to lift the broken bone to its original position or in the case if the floor of the orbit is broken, it is necessary to remove the broken bone and reconstruct the orbital floor bone with bone or cartilage or with other tools. suitable material. If there is a soft tissue lesion around the orbit, reconstruction is required.

Notes after surgery: After surgery, patients need to rest properly, avoid blowing their nose and doing heavy activities 2-3 weeks after surgery. Use the correct and sufficient medication as directed by your doctor. Schedule follow-up after surgery. When the floor of the eye socket is broken, it will leave sequelae affecting aesthetics and function for the patient. Early detection has better treatment capacity, late cases, sequelae are difficult to repair and treatment results are not high. If after an injury, if there are suspicious signs, it is necessary to go to a reputable medical facility for early examination and treatment.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, modern equipment and technology, but also stands out for its examination and consultation services. comprehensive and professional medical consultation and treatment; civilized, polite, safe and sterile medical examination and treatment space. Customers when choosing to perform tests here can be completely assured of the accuracy of test results.
With 10 years of experience in the field of Ophthalmology, she used to work at Thai Nguyen Central Hospital and held the position of deputy head of the department and in charge of the Department of Ophthalmology at Thai Nguyen University of Medicine and Pharmacy. Master Hoang Thanh Nga has a lot of experience in the field of examination and treatment of eye diseases. Currently, he is an Ophthalmologist at the Department of General Internal Medicine, Vinmec Ha Long International General Hospital.