From the Guidelines
The management of an orbital floor fracture with no displacement typically involves a conservative, non-surgical approach with close observation, as waiting 4 to 6 months after orbital trauma is advised because strabismus may resolve on its own unless there is substantial fat and orbital pulley entrapment for which earlier repair is beneficial 1. Patients should be advised to avoid activities that could increase intraorbital pressure, such as nose blowing, heavy lifting, and strenuous activities, for a period of 2-3 weeks. Symptomatic treatment may include oral analgesics for pain control, such as acetaminophen or ibuprofen, and a short course of oral antibiotics if there is communication with the sinus to prevent infection. Some key considerations in the management include:
- Avoiding activities that increase intraorbital pressure
- Symptomatic treatment for pain and potential infection
- Use of nasal decongestants to reduce sinus pressure
- Application of cold compresses for the first 48 hours followed by warm compresses to manage swelling
- Follow-up at 1-2 weeks with repeat imaging to ensure the fracture remains stable This approach is supported by the understanding that non-displaced orbital floor fractures typically heal well without surgical intervention, provided there are no complicating factors such as diplopia, enophthalmos, or restriction of extraocular movements that would necessitate surgical repair 1.
From the Research
Management Approach
The management approach for an orbital floor fracture with no displacement involves a thorough evaluation and a thoughtful management strategy.
- Conservative management may be considered for certain patients with orbital floor fractures, as some studies have demonstrated that these patients can do well without surgical intervention 2.
- However, precise surgical dissection and adequate fracture reduction are essential to restoring orbital anatomy and function in patients who require operative repair 2, 3.
Surgical Techniques
Various surgical techniques can be used to repair orbital floor fractures, including:
- Endoscopically assisted repair, which can minimize ocular globe manipulation and eliminate the need for a lower eyelid incision 4.
- Transantral endoscopy, which allows for the reduction of floor fractures and prolapsed orbital tissue into the orbital cavity 4.
- The use of enophthalmic implants, such as high-density porous polyethylene (Medpor) implants, to augment orbital volume and improve enophthalmos and hypoglobus 5.
Conservative Therapy
Conservative therapy may be frequently indicated in blow-out fractures of the orbit, and can involve:
- Eye movement exercises to resolve diplopia 6.
- A "wait and see" approach to allow for spontaneous resolution of diplopia in patients with edema or oculomotor nerve palsy 6.
- Surgery may be necessary to reduce diplopia in patients with enophthalmos or adhesions around the lower eye muscles and the orbital floor 6.