Investigation and management of orbital trauma

Clinical examination and conventional radiography of the orbit following recent orbital trauma often gives an incomplete picture of the damage present. In many infra-orbital blowout injuries, damage to the medial orbital wall occurs with prolapse and sometimes incarceration of orbital contents into both the maxillary and ethmoidal air sinuses. Late enophthalmos is thought to be caused by both atrophy of orbital fat and its loss into the paranasal sinuses. Hypocycloidal tomography in an antero-posterior plane is helpful in the recognition of those defects, but it does not distinguish between the presence of blood clot and soft tissue. Computerised axial tomography (C.A.T.) and ultrasonography are currently available investigative techniques which do distinguish between the presence of air, blood clot, soft tissue and bone and, in addition, there is a significant reduction in radiation dosage when compared with tomography. A comparison of these techniques and the clinical findings is described. These investigations should indicate the necessity for surgical intervention and prevent some of the late complications, such as enophthalmos.