Orbital fractures: role of imaging

The orbit may be injured directly or indirectly. Blunt and penetrating trauma occurs with equal frequency. Soft tissue swelling often obscures direct clinical evaluation of the globe, limits ocular motion, and may limit clinical assessment of vision. Plain film radiographs of the orbits and sinuses are rarely used for diagnosis in orbital trauma. Computed tomography is considered the imaging modality of choice in this circumstance, as it is deemed to be the most accurate method in detecting fractures. The protocol is based on obtaining thin-section axial scans and multiplanar reformatted images, both are useful tools to guide treatment. Orbital fractures are not considered an ophthalmologic emergency unless there is visual impairment or globe injury. Surgical repair is indicated for patients who have persistent diplopia or cosmetic concerns (enophthalmos) and generaly is not performed until swelling subsides 7-10 days after injury.