From the Guidelines
Orbital fractures are classified based on their anatomical location and the specific walls of the orbit involved, including isolated wall fractures, blow-out fractures, blow-in fractures, and complex fractures involving multiple walls or the orbital rim. The most common classification system divides orbital fractures into these categories, which helps guide clinical assessment and surgical management 1. The orbital floor is the most frequently fractured wall due to its thin bone structure, particularly in the posteromedial aspect. Medial wall fractures often occur in conjunction with floor fractures, while lateral wall and roof fractures are less common and typically result from more severe trauma.
Key Classification Categories
- Isolated wall fractures: including orbital floor, medial wall, lateral wall, and roof fractures
- Blow-out fractures: where increased pressure causes the orbital contents to herniate through the weakest point
- Blow-in fractures: where bone fragments are displaced into the orbit
- Complex fractures: involving multiple walls or the orbital rim Zygomaticomaxillary complex (ZMC) fractures involve the lateral orbital wall and rim, and naso-orbito-ethmoid (NOE) fractures affect the medial orbital wall and rim. This classification system is crucial in guiding treatment decisions, which are based on fracture location, size, presence of muscle entrapment, and functional or aesthetic impairment 2, 3.
Important Considerations
- The presence and pattern of ocular misalignment may indicate other orbital or central nervous system trauma guiding imaging and treatment 1
- Determining the cause of diplopia after orbital trauma requires a detailed history, examination, and often imaging 1
- Treatment decisions should prioritize minimizing morbidity, mortality, and improving quality of life, with a focus on prompt repair of fractures with entrapped muscle or periorbital tissue, and addressing symptomatic diplopia and other complications in a timely manner 2