Orbital floor fractures: evaluation, indications, approach, and pearls from an ophthalmologist's perspective

Blunt trauma to the orbital rim is a frequent cause of orbital floor fractures. Although orbital floor fractures often occur in association with other facial trauma, the term "blowout fracture" is reserved for isolated orbital floor fractures with an intact orbital rim. Many surgical specialties--including ophthalmologists, otolaryngologists, maxillofacial specialists, and plastic surgeons--evaluate and treat floor fractures. The wide range of treating physicians means that varying levels of expertise and experience are involved in care of patients with periorbital trauma. Although each subspecialty can offer pearls from their basis of training, the purpose of this article is to offer insights on orbital floor fractures from the ophthalmic plastic and reconstructive surgeon's perspective. Particular emphasis will be placed on ophthalmic portions of the examination and treatment plan; all in an attempt to avoid ophthalmic complications. This review is meant to be a user-friendly guide to the evaluation and treatment of orbital floor fractures from an ophthalmic perspective.