What is enophthalmos of the eyeball. Fracture of the orbit (eye orbit): danger, operation, consequences Is enophthalmos dangerous for humans

Both of these processes are not independent eye diseases, but manifestations, symptoms of other diseases, both of the organ of vision and of the endocrine, nervous systems, a consequence of injuries, tumors, and vascular pathology.

Exophthalmos and enophthalmos are divided into:

true;
false (imaginary).

False is caused by anomalies in the development and structure of the bones of the skull, when, with normal parameters of the eyeballs, the size of the orbit increases or decreases: bone anomalies (tower skull, unequal size of the orbits), ocular (an increase or decrease in it, for example, microophthalmia; an increase associated with a high degree of myopia ).

If true, the changes will affect the tissues surrounding the eyeball. In the future, we will talk about true exophthalmos and enophthalmos.

THE REASONS

The process can develop at any age, is a manifestation of various diseases, including congenital ones; general and local. Occurs due to changes in the tissues surrounding the eyeball, of a different nature (inflammatory, vascular, tumor processes, endocrine dysfunction, innervation disorders, trauma, etc.).

The most common causes of exophthalmos are:

Extraorbital:

diseases of the nervous, endocrine systems (thyrotoxicosis);
blood (leukemia);
nose and paranasal sinuses;
brain and its membranes.

Intraorbital:

tumors of the orbit, optic nerve, eyeball;
inflammation of the tissues of the wall of the orbit, the eyeball, orbital tissue;
vascular pathology (, thrombosis, hemorrhage, varicose veins of the orbit).

One-sided process usually occurs in eye diseases, bilateral - in general, systemic diseases.

The most common causes of enophthalmos are:

disorders of sympathetic innervation;
severe injuries of the walls of the orbit;
other processes (metabolic, inflammatory, age-related), as a result of which atrophy (reduction in size) of the tissues of the orbit occurs.

CLASSIFICATION

Variants of true exophthalmos:

permanent - develops gradually, the result of subacute and chronic processes (tumors and inflammation of the orbital wall and neighboring areas, cerebral hernia, endocrine dysfunction);
intermittent - appears when the head is tilted, with physical effort, compression of the veins of the neck;
pulsating - there is a pulsation of the diseased eye in time with heart contractions, accompanied by noise (during auscultation), occurs with injuries and some types of vascular pathology;
progressive (malignant) - a rapid increase in exophthalmos, which is difficult to treat, is accompanied by severe disorders of the organ of vision, occurs with severe endocrine dysfunctions.

Varieties of enophthalmos:

imaginary is associated with a decrease in the size of the eyeball;
early occurs with an acute injury with a fracture and displacement of the bone walls, develops immediately after the injury;
late develops gradually.

SYMPTOMS

A small degree of severity, usually asymptomatic, does not cause discomfort to the patient, except for a visual defect.

With an increase in the degree of exophthalmos, the following are added:

pain sensations;
blurred vision;
limitation of eye movements;
congestive changes during examination of the fundus (edema and / or atrophy of the optic nerve, retinal hemorrhages, etc.);
redness of the mucous membrane of the eyelids and conjunctiva;
dry eye (a complication of this may be corneal ulcers);
increase in intraocular pressure.

Exophthalmos is observed in the following diseases:

1. Diseases of the nervous system - in addition to neurological manifestations specific to a particular disease, the Pourfure du Petit symptom complex often occurs: exophthalmos, mydriasis (pupil dilation), an increase in the size of the palpebral fissure. This triad of symptoms is caused by increased sympathetic innervation in case of irritation of the cervical sympathetic trunk.

2. Inflammatory diseases of the eyeball, walls and contents of the orbit:

abscess;
phlegmon;
cellulite;
periostitis of the orbit;
panophthalmitis.

In all cases, there are general phenomena of intoxication (fever, chills, headache) and local manifestations of inflammation (hyperemia and swelling of tissues, severe pain - spontaneous and palpable).

3. Intermittent exophthalmos, which develops against the background of varicose veins of the ophthalmic veins, sometimes occurs suddenly - during exercise.

A characteristic feature is the protrusion of the eye when the head is tilted. In a vertical position or lying on the back, the phenomena of exophthalmos disappear or are significantly reduced;

4. Pulsating exophthalmos: the internal carotid artery passes through a formation of the dura mater called the cavernous sinus, and if the vessel ruptures in this place (mainly due to trauma to the base of the skull), arterial blood flows into the sinus and from there into the superior ophthalmic vein. The latter expands, presses and displaces the eye.

After a sudden onset, in which the patient complains of significant noise in the ears, head and severe headache, a protrusion and a visually detectable pulsation of the eyeball join, while noise is heard above it. The saphenous veins of the adjacent part of the face, head may expand, the oculomotor nerves may be affected, and the optic nerve also suffers.

Endocrine ophthalmopathy

1. Thyrotoxic exophthalmos: a bilateral process, a consequence of thyrotoxicosis. Women get sick more often. The pathogenesis of the process is a combination of vasomotor disorders, an increase in the tone of some muscles of the eye, including the lifting of the upper eyelid, against the background of increased sympathetic innervation. Typical eye symptoms specific to this type of exophthalmos are:

Shtelvaga - infrequent blinking, because of this - a gaze;
Grefe - lag of the upper eyelid when lowering the eyes;
Möbius - difficulty of convergence (rapprochement of the eyes to the median line when looking at a closely located object). There is an increase in the palpebral fissure, long-term preservation of eye mobility even with a high degree of exophthalmos.

2. edematous exophthalmos develops with increased function of thyroid hormones - hyperthyroidism. It debuts with intermittent ptosis: the upper eyelid is slightly lowered in the morning, and returns to its normal position in the evening. Later, exophthalmos, swelling of the periorbital tissues joins, intraocular pressure rises and, if left untreated, the eyes become immobile, vision deteriorates.

3. Endocrine myopathy develops against the background of hypo- or euthyroidism (low and normal thyroid function, respectively), men are more likely to suffer, the process is bilateral. Morphological substrate - swelling of the orbital tissue and eye muscles, followed by their compaction. It debuts with diplopia (double vision), then exophthalmos and inactivity of the eyeball appear.

4. Progressive malignant exophthalmos occurs with dysfunction of the hypothalamic-pituitary region, namely, excessive production of thyroid-stimulating hormone. This may be against the background of the pathology of the thyroid gland, after its removal (thyroidectomy), with, in the complex of diencephalic syndrome. Thyroid function is usually not impaired.

The course is rapidly progressive, the degree of protrusion of the eye is significant, up to its spontaneous dislocation. Accompanied by severe pain, swelling, immobility of the eye (especially upward and outward), the development of complications - keratitis, glaucoma, optic nerve atrophy.

Symptoms of enophthalmos

Visually noticeable deep location of the eyeball and narrowing of the palpebral fissure. In addition, the following are noted:

aggravation of the fold between the eye and the lower eyelid;
the appearance of folds on the upper eyelid;
often - diplopia (double vision);
decreased visual acuity (especially with injuries, when the tissues of the eye are also damaged);
decreased eye movement.

With a weakening of sympathetic innervation (due to damage to the cervical sympathetic trunk), the Bernard-Horner symptom complex develops with a triad of symptoms: ptosis (drooping of the upper eyelid and narrowing of the palpebral fissure), miosis (narrowing of the pupil), enophthalmos.

DIAGNOSTICS

Diagnosis of both deviations is carried out, first of all, by an ophthalmologist, other specialists also take part in the diagnosis, depending on the pathology against which exophthalmos developed: a neurologist, endocrinologist, otolaryngologist, neurosurgeon, oncologist, maxillofacial surgeon.

The most common methods:

inspection;
palpation of the eyeball (determination of its size, consistency, mobility, tone) and surrounding tissues;
exophthalmometry is carried out using a ruler or exophthalmometer (a device with a graduated ruler and mirrors). Exophthalmos is considered to be the protrusion of the eyeballs from the orbits by more than 20 mm;
orbitotonometry is performed using a piezometer equipped with a pressure gauge and a set of interchangeable weights, under local anesthesia, the displacement of the eyeball, the elasticity of its surrounding structures are assessed, which helps in the differential diagnosis of the nature of exophthalmos (tumor or non-tumor);
x-ray studies, computed tomography;
ultrasound procedure;
radioisotope methods.

TREATMENT

Therapy is carried out by an ophthalmologist in collaboration with other doctors (neurologist, endocrinologist, otolaryngologist, neurosurgeon, oncologist), depending on the underlying disease, against which exophthalmos or enophthalmos developed.

The main methods of treatment:

In inflammatory processes - broad-spectrum antibiotics, detoxification therapy, surgical opening of abscesses.
Pulsating exophthalmos - pressure bandage, local X-ray therapy, sometimes - ligation of the carotid artery.
Endocrine ophthalmopathy: treatment of the underlying disease (thyroid pathology), glucocorticoids are widely used, as well as symptomatic treatment of eye complications.
Malignant exophthalmos: X-ray therapy is often applied to the region of the orbits and pituitary gland.

In some cases of exophthalmos, it is advisable to perform decompression trepanation of the orbit, plastic surgery to eliminate a cosmetic defect.

PREVENTION

There is no specific prevention. Early diagnosis and treatment of diseases against which exophthalmos can develop is important. This will prevent visual complications, often irreversible, arising from this process.

PROGNOSIS FOR RECOVERY

Recovery depends on the causes that caused exophthalmos, and the possibility of their successful elimination. In this case, the prognosis is favorable. The phenomena of a small exophthalmos may remain, but the function of vision will not suffer.

Recovery from enophthalmos is possible in case of successful treatment of the underlying disease. Serious visual disturbances are rare.

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Enophthalmos is a deeper position of the eyeball compared to the norm. There is also the opposite phenomenon - exophthalmos (bulging eyes). Both conditions are pathological, but they can be detected only at the middle stage of development, when the defect can be eliminated only with the help of an operation. Consider the causes, signs and methods of treatment of enophthalmos.

Enophthalmos of the eyeball

Often, enophthalmos of the eyeball occurs due to trauma. Mechanical trauma to the eye and orbit can lead to the destruction of soft tissues or the temporal lobe. The volume of the orbit is 30 ml. The eyeball occupies only 6.5 ml of this volume. In this regard, severe trauma can easily contribute to the displacement of the eye. As a rule, this is accompanied by ptosis (drooping) of the upper eyelid and miosis, when the muscles of the lens atrophy and the pupil narrows regardless of external factors and remains in this state. When the eye sinks into the orbit, we are talking about enophthalmos. Protrusion of the eyeball (bulging eyes) is diagnosed with exophthalmos.

Enophthalmos is congenital and acquired. The first form of this pathology is due to factors such as:

Abnormal structure of the bones of the skull.

An increase in the size of the anatomical axis of the eyeball - the line that connects the axes of the eye.

Lipodystrophy is a pathology characterized by degeneration of adipose tissue.

Violation of trophism - the process of cellular nutrition.

The causes of acquired enophthalmos can be of an ophthalmic nature, and it also happens when there is no connection with diseases of the organs of vision.

The first group of factors includes:

Microphthalmos is a reduction in size of the eye. Usually develops in a unilateral form. The causes of this pathology can also be congenital and acquired. Microphthalmos can be detected during the initial examination of the eye.

Orbital fracture.

Atrophy of the orbit caused by mechanical trauma.

Subatrophy of the eye, manifested in the slow drying of its tissues.

Sometimes enophthalmos is due to causes that are not related to the organs of vision. Eyeballs can shift with severe exhaustion of the body, dehydration. This is usually caused by diseases such as cholera, peritonitis, anorexia. Oncological diseases, including brain tumors, are often accompanied by enophthalmos. Damage to the cervical spine can also lead to a displacement of the eye in the orbit.

Horner's syndrome and enophthalmos

There is such a symptom complex as Horner's syndrome, which is caused by damage to the sympathetic nervous system. With this syndrome, ophthalmic disorders are observed: miosis, ptosis, enophthalmos. There is also dyshidrosis, a sweating disorder where one part of the face sweats more than the other. The syndrome is primary (from birth) and secondary (acquired). The first form is extremely rare, and the second can be caused by a variety of reasons: head injuries, thyroid diseases, inflammation of the middle ear, brain tumor, aortic aneurysm, sympathetic nerve cut, multiple sclerosis, blockade of nerve centers. Any form of Horner's syndrome is difficult to treat.

Stages of development of enophthalmos

At an early stage, this pathology can be noticed after an injury in which the walls of the orbit were fractured. Enophthalmos will be detected immediately upon examination. With damage to the optic nerve, atrophy of the tissues of the orbit, or in the presence of a congenital anomaly of the eye, an apparent enophthalmos is observed. The late form of the disease develops against the background of inflammatory eye diseases, as a result of slowly dissolving hematomas and damage to the spine, in particular the cervical region.

Symptoms of pathology depend on the causes of its occurrence and stage of development. Enophthalmos can manifest itself as follows:

asymmetric location of the eye sockets;

diplopia;

narrowing of the visual fields or loss of entire sections from them;

deterioration of visual functions;

increased photosensitivity;

the appearance before the eyes of "flies", iridescent circles, spots;

lacrimation;

drooping of the upper eyelid and narrowing of the palpebral fissure;

insufficient mobility of the eye;

permanent miosis.

If enophthalmos is caused by a lesion not of the organs of vision, but of other body systems, the following can be observed:

increased or, conversely, decreased body temperature (up to critical levels);

weight loss;

nausea, vomiting, other signs of gastrointestinal dysfunction leading to dehydration;

general weakness of the body, growing malaise;

pallor of the skin;

headaches and dizziness;

unstable blood pressure;

sudden mood swings, depression, apathy and other psychological disorders.

These symptoms are difficult to diagnose enophthalmos, but none of them is recommended to be ignored. It is necessary to consult a therapist and undergo an examination. In the presence of ophthalmological signs listed above, you should make an appointment with an ophthalmologist. Enophthalmos can lead to irreversible pathological processes that will eventually cause complete blindness.

Diagnosis of enophthalmos

If the displacement of the eyeball is provoked by trauma, the doctor determines the degree of injury. He must establish the nature of the damage, the current clinical picture of the pathology. Visual acuity is also checked, studies are carried out for the presence of inflammatory and infectious diseases. If the primary ophthalmic examination methods do not give a complete picture, methods such as:

general blood analysis;

test for human immunodeficiency virus (HIV) and hepatitis;

eye ultrasound;

computed tomography and MRI of the brain.

Based on all the data obtained, a decision is made on the method of treatment. It can be conservative or surgical.

Enophthalmos: treatment without surgery

Conservative treatment consists in the use of medications. Usually prescribed antibacterial drops, non-narcotic analgesics, corticosteroids, vitamin complexes that strengthen the immune system. The type of drug depends on the cause that caused the enophthalmos. Drug therapy is effective only in the early form of pathology. Further displacement of the eyeball cannot be corrected with medication. This will require an operation.

Surgery as a way to treat enophthalmos

A surgical operation is prescribed immediately in case of injuries, if a fracture of the bones of the orbit has occurred. The surgeon during the procedure must remove all bone fragments. Also, this method of treatment is used to eliminate enophthalmos with a strong displacement of the eye into the orbit. The essence of the operation is as follows: the doctor introduces an implant under the lower wall of the orbit, which will support the eye in the desired position. Similar implants are made from silicone, polymers and various metals, including titanium. If treatment is started in a timely manner, the pathology can be eliminated quickly enough and visual functions can be preserved.

Prevention of enophthalmos

As is clear from the above, there is no risk group when it comes to enophthalmos. This pathology can develop in anyone. The congenital form is usually diagnosed at an early age. In older people, enophthalmos occurs mainly due to the drying of tissues and a decrease in the volume of retrobulbar tissue, which is a natural shock absorber for the eye. In order to prevent enophthalmos, ophthalmologists recommend that safety precautions be observed at work (wear goggles or masks). It is important to undergo ophthalmological examinations annually, treat all diseases on time, lead a healthy lifestyle, and take vitamins.

The nature of the development of enophthalmos depends on the degree of damage. Atrophic processes are always irreversible. Those tissues that die as a result of atrophy cannot be restored. Along with them, visual functions are lost forever. However, often enophthalmos is treated quickly and successfully.

Enophthalmos - the main symptoms:

Weakness
Elevated temperature
Nausea
Vomit
spots before the eyes
Double vision
lacrimation
Low temperature
Photophobia
Pale skin
Decreased vision
Upper eyelid droop
Weight loss
Loss of parts of the field of view
Pupil constriction
Reduction of the palpebral fissure
Colored circles before the eyes
Limited mobility of the eyeball
Retraction of the eyeball
Asymmetrical arrangement of eye sockets

Enophthalmos is an ophthalmic disease characterized by an abnormal position of the eyeball in the orbit. Both its deepening and protrusion are observed. Pathology of this kind can be caused by trauma, then they talk about post-traumatic enophthalmos or caused by other etiological factors.

Enophthalmos refers to such pathologies, the elimination of which is almost impossible only through conservative therapeutic measures. In most cases, they resort to operable intervention, which allows not only to eliminate the pathology, but also to minimize the risk of complications.

The clinical picture is well expressed only at the middle stage of the development of the disease. In the initial stages, if the cause is not mechanical damage, symptoms can only appear in an external defect.

It should be noted that quite often this pathological process is combined with eyelid drooping and miosis. If treatment is not started in a timely manner, serious complications may develop. The prognosis is individual.

Causes of enophthalmos

Enophthalmos can be either congenital or acquired. Depending on this, the causes of the development of the pathological process are also distinguished.

Congenital may be due to the following etiological factors:

anomaly in the structure of the bones of the skull;
increase in the size of the sagittal axis;
lipodystrophy;
trophic disturbance.

As for the acquired forms of development of such a pathological process, there are such reasons as:

sclerotic changes in bone tissue;
reduction of the eyeball;
fracture of the bone structures of the orbit;
eye socket injury, which leads to soft tissue atrophy;
microphthalmos;
subatrophy.

Also, the development of such a disease may be due to reasons that are not directly related to the organs of vision.

These should include:

dehydration;
severe depletion of the body;
severe inflammatory diseases transferred the day before;
the presence of oncological diseases in history;
cholera;
peritonitis;
an attack of agony;
paraneoplastic syndrome;
damage to the cervical spine.

It should be noted that in such cases, enophthalmos can be characterized not only by the deepening of the eyeball into the orbit, but also by protrusion. This, for example, occurs during agony.

Classification

According to the nature of the occurrence, two forms of the pathological process are distinguished:

congenital;
acquired.

According to clinical and morphological features, the following forms of the course of this disease are considered:

early enophthalmos - develops immediately after an eye injury;
apparent - diagnosed with damage to the optic nerve, tissue atrophy or congenital defects of the eyeball;
late enophthalmos - develops against the background of inflammatory diseases of the eyes, long-term absorbable hematomas, lesions of the cervical spine.

Determining the nature of the course of the pathological process is possible only by carrying out the necessary diagnostic measures. Based on the results of the diagnosis, the doctor can determine the most effective treatment for such an eye disease.

Symptoms of enophthalmos

The clinical picture of such a pathology can be characterized as follows:

retraction of the eyeball - enophthalmos 2 mm or more;
asymmetric location of the eye sockets;
double vision;
loss of areas of vision;
constant constriction of the pupil;
limited mobility of the eyeball;
decreased visual acuity;
photophobia;
increased lacrimation;
the appearance of spots, flies, colored circles before the eyes;
narrowing of the palpebral fissure;
omission of the eyelid.

In the event that the pathological process is not caused precisely by damage to the organs of vision, general symptoms may be present, namely:

increase or decrease to critical temperature levels;
weight loss;
nausea and vomiting, which leads to dehydration;
weakness, growing malaise;
pallor of the skin;
dysfunction of the gastrointestinal tract;
unstable blood pressure;
decrease in working capacity;
headaches, dizziness;
psychological disorders - depression, irritability, mood swings, apathy.

With such clinical signs, you should immediately seek medical help - you cannot self-medicate or ignore the problem. This can lead to irreversible pathological processes, including complete loss of vision.

Diagnostics

Diagnosis is based on a physical examination and laboratory and instrumental methods of examination of the patient.

During the initial examination, the doctor should establish the following:

if the cause is an injury, how and when it was received;
the nature of the course of the clinical picture;
visual acuity of the patient;
the presence of chronic infectious or inflammatory diseases in a personal history;
the presence of oncological diseases from ophthalmology.

In addition, the following laboratory and instrumental diagnostic methods are carried out:

general blood analysis;
test for HIV, hepatitis;
visometry;
Ultrasound in B-mode;
CT, MRI of the orbit;
exophthalmometry;
radiography.

Exophthalmometry

If an anomaly in the structure of the bones of the skull is expected, then a CT or MRI of the brain is additionally performed. Laboratory tests, as a rule, are not mandatory, as they are not of diagnostic value.

Taking into account the results of the diagnosis, as well as the data that were collected during the initial examination of the patient, the doctor determines further therapeutic measures to eliminate the pathological process.

Treatment of enophthalmos

Conservative treatment takes place only if an early stage of the development of the pathological process is diagnosed and the displacement of the eyeball is not more than 2 mm.

In this case, the following drugs are prescribed:

corticosteroids;
antibacterial;
non-narcotic analgesics;
vitamin and mineral complex to strengthen the immune system.

If the inflammatory process is pronounced, then detoxification therapy is additionally carried out.

Radical treatment can be carried out as follows:

by subciliary access;
through transconjunctival access;
by transaortic access.

Implants made of silicone, polymer compounds can be implanted.

The prognosis, if the treatment is started in a timely and correct manner, is favorable - the pathology can be completely eliminated, with the preservation of vision.

Prevention

There are no specific methods of prevention, so you should follow the general recommendations:

when in potentially dangerous areas, it is necessary to observe safety precautions - use protective equipment for the head and face, adhere to the rules for moving around the territory;
carry out the prevention of infectious, inflammatory diseases, and if there are any, then begin their treatment in a timely manner;
normalize sleep and work patterns;
eat right - the diet should be balanced, contain the necessary trace elements and vitamins.

If you are injured or have the clinical signs described above, you should seek immediate medical attention. Timely treatment significantly increases the chances of a full recovery.

What to do?

If you think that you have enophthalmos and symptoms characteristic of this disease, then an ophthalmologist can help you.

Enophthalmos is a disease that causes the eyeball to shift into the posterior orbit. It is accompanied by a deterioration in visual acuity, a change in eye mobility, the development of cattle and diplopia.

Diagnosis is carried out with the help of examination, palpation, visometry procedures, radiography, exophthalmometry. Ultrasound and tomography are also performed. Treatment tactics depend on the type of pathology. With a reduced volume of retrobulbar tissue, implantation is indicated. If the cause of the disease is traumatic, reposition of bone fragments is prescribed. With inflammation, a course of therapy is prescribed.

The disease was described at the end of the 19th century by the British surgeon W. Leng.

Currently, the congenital form of enophthalmos occurs in patients of both sexes. Often, pathology is detected in children. Traumatic enophthalmos occurs in men after 40+. The cause of age-related enophthalmos after 60+ is natural processes that eventually reduce the volume of retrobulbar tissue. The region of residence for the development of enophthalmos is not important.

The reasons

Enophthalmos can be caused by a decrease in the diameter of the eyeball due to microphthalmos or traumatic subatrophy. Sclerosis of the soft tissues of the orbit is caused by age-related features (atrophy of the retrobulbar fiber). One of the common causes of eyeball retraction is trauma to the structures of the orbit: destruction in the region of the infraorbital foramen, fractures of the zygomatic bone, etc.

With neoplasms in the cavity of the orbit (for example, retinoblastoma), exophthalmos occurs, which, after surgery and radiation therapy, passes into enophthalmos.

An enlarged thyroid gland, aneurysm compression, exhaustion of the body, peritonitis, etc. can favor the development of enophthalmos. Often, enophthalmos affects only one eye, asymmetry begins to be determined when the eyeball sinks 1 mm or more. Enophthalmos may be accompanied by the appearance of folds on the upper eyelids due to retraction of the orbital-palpebral sulcus.

Varieties

There are three forms of the disease: early, late and imaginary.

An early form of enophthalmos occurs immediately after an injury. May be maxed out by edema of the retroorbital tissue.

The late form occurs against the background of atrophy of the muscles that control the eye, hypoplasia and sclerosis of soft tissues. The main causes are hemorrhage or inflammation. Clinically imaginary form is close to congenital microphthalmos.

Symptoms

The main complaints in enophthalmos are double images, falling out fragments of the visual field, marked pupillary constriction, and decreased eye mobility. Visual acuity is reduced due to damage to the retina or optic nerve due to trauma. A characteristic sign of enophthalmos is a deterioration in the trophism of the oculomotor muscles. Over time, this causes them to atrophy. In some cases, strabismus may occur.

Enophthalmos may be symptomatic of other anomalies, such as oculosympathetic Bernard-Horner syndrome or Parry-Romberg disease.

Diagnosis of enophthalmos

The main research methods are external examination, digital examination, measurement of the degree of protrusion of the eyeball, X-ray, tomography and ultrasound.

On examination, the displacement of the eyeball inward, the narrowing of the palpebral fissure, the change in the skin fold over the upper eyelid are determined. With the help of exophthalmometry, the position of the protruding or receding eyeball is determined by at least 1 mm.

With the help of radiography, it is possible to determine the boundaries of fractures and the size of the displacement of bone fragments. The size of the pathology is determined by tomography of the orbit. Usually, in the axial projection, the distal displacement of the eyeball is noticeable, bone fragments, atrophy of muscle fiber and fiber around the eyeball are determined.

The degree of vision loss is determined by visometry.

Treatment of enophthalmos

The choice of treatment depends on the origin of the disease. If the disease is caused by a contraction of the retrobulbar tissues, an injection is made from one's own fat cells taken from the patient's anterior abdominal wall. So you can bring the eyeball into the right position, avoiding complications. During surgical treatment, implants made of polymers or titanium are installed in the retrobulbar space.

Conservative therapy for enophthalmos after trauma is reserved for patients with mild symptoms (posterior displacement less than 2 mm) without interposition of the inferior rectus extraocular muscle and in the absence of double vision. The tactics of treatment is reduced to the appointment of a course of antibacterial drugs and corticosteroids. After traumatic enophthalmos, bone fragments are repositioned. If damage is minimal, endoscopic surgery is performed.

Pain syndrome is relieved by non-narcotic analgesics. Edema is removed by instillation of hypertonic saline solutions. With inflammation of the retrobulbar tissue, a course of conservative therapy is carried out.

Prevention

Measures to prevent the disease: compliance with safety rules at home and at work, reasonable diagnostics, a well-thought-out diet, the correct mode of work and rest.

Anatomical fossa on the skull. Most often, fractures are combined, that is, they are found in combination with trauma to other bones of the facial part of the skull, such as, for example, the frontal, temporal, zygomatic, maxillary or bone tissue of the root and back of the nose, the walls of the orbit itself.

Description of injury

Injury to this zone is very dangerous, because fractures of any of the constituent walls of the orbit are almost always accompanied by a concussion of the brain.

In addition to the combined fracture, a rare (about 16.1% of all cases) isolated orbital fracture is also distinguished, which is usually the result of a direct blow towards the eyeball. Moreover, more often the blow occurs from the side of the lower or inner wall, that is, precisely those walls that limit the cavity of the orbit. Hence the name "explosive" injury.

Subcutaneous emphysema - accumulation of air as a result of traumatic "exposure" and ingress of gas from the cavity of the orbit into the adjacent paranasal sinuses. This phenomenon is most often detected after a strong exhalation through the nose, after which the air that has entered the subcutaneous formations, as it were, "crunches" when pressed on the periorbital region.

Often there is a pinching of the lower rectus muscle, especially with a fracture of the bottom of the orbit, therefore, there is a restriction in the movement of the eye upward, and causes the development of diplopia (double vision).

In addition, hemorrhage into the muscles or surrounding tissues is possible with limitation of mobility already down.

The main symptoms of a fracture of the orbit

This disease is manifested by the following symptoms:

Diagnostics

Diagnosis of a fracture of the orbit:

Additional diagnostics

Signs of proptosis and prose are found in a significant part of the victims, as a result of traumatic hemorrhage in tissues and muscles and swelling in the facial region of the skull. On examination, foreign bodies of various sizes and structures can be detected. Approximately 30% of all "explosive" fractures of the orbit are combined with the development of erosion of the horny phenomena of traumatic hyphema (the presence of signs of hemorrhage in the anterior chamber), iritis (inflammation of the iris), rupture of the eyeball, signs of concussion of the retina, its detachment and, finally, hemorrhage.

The severity of the fracture of the orbit is high.

It is preferable to carry out and for a better idea of the state of the walls of the orbit, it is desirable to carry out axial and coronal thin sections.

To detect a fracture and introduce the contents of the orbit into adjacent sinuses, it is necessary to examine the inner (medial) part of the bottom and the wall adjacent to the nasal bone.

Examination of the bone top allows you to identify the condition of the posterior edge of the bone, which is mandatory during surgery.

The main manifestations depend on the strength of the applied blow to the facial part of the skull and associated injuries: for example, with a fracture of the predominantly upper wall, the percentage of brain concussion is high. In case of a fracture of the lower or inner (medial) wall, mucous membrane secretions may spread through the lesions into the paranasal sinuses with concomitant infection.

Principles of therapy

The goal of treatment is aimed at preserving or restoring the structure of the orbit and its contents, that is, the eyeball (restoring the range of motion of both active and passive muscles, eliminating such unpleasant accompanying symptoms as diplopia or, for example, strabismus, causing significant discomfort to the victim).

Often in this situation, they resort to surgical intervention, which at the same time has an adverse effect on the contents of the orbit, manifested in the form of excessive pressure on the eyeball. The danger also lies in the fact that the hemorrhage that occurred behind the eye several times increases the pressure exerted on the optic nerve, and mainly on its disc, which entails not only a deterioration in vision, but also in an unfavorable outcome and its complete loss.

Since the injury also involves a lot of other anatomical components of the skull, therefore, the load on these affected parts is also prohibited, in particular, the pressure exerted on the airways. A simple effort, even a slight one, for example, when blowing your nose, leads to an increase in pressure inside the cavity of the zygomatic arch, which exacerbates swelling and can provoke a complete closure of the eye, or contribute to the development of subcutaneous emphysema.

Indications for surgical intervention

Consider the cases in which the operation is shown:

Types of eye fracture surgery

According to the timing of the operation, early surgical intervention is performed, performed in the acute period of injury, within the first two weeks, that is, precisely in the period of time when there are the most optimal conditions for restoring the integrity and ensuring adequate physiological functioning of the affected organ. Also, the operation can be delayed, performed after a two-week period, but up to the fourth month after the so-called " gray period". And, finally, late medical care, requiring mandatory osteotomy.

The most effective methods of treatment include surgical, in which there are several methods for correcting the bone tissue of the orbit and zygomatic arch. All of them are similar in that they are made through small incisions, which then heal, that is, they become completely invisible.

This operation can be performed from the side of one of the walls of the orbit, may include providing extended access to the opening of the fracture area and the subsequent possibility of using various types of prostheses.

Sequelae of an eye fracture

An orbital fracture is a severe injury. Help must be provided in a timely manner. Otherwise, dangerous, highly undesirable complications and consequences may occur. The visual function is disturbed, it threatens with an absolute and irreversible loss of vision.

The most common consequences are the development of strabismus, diplopia. Possible concussion, pain shock, concomitant injuries. Complications of an infectious nature are not excluded. Lack of treatment leads to the formation of fibrous, bone growths.

Thanks to the achievements of modern medicine, the undesirable consequences listed above are prevented, and the visual function of the victim is also fully restored.