The eye orbit or the orbital area can be understood simply as being two sockets which are located in the skull. Within these two sockets our eyes are located. The orbital anatomy may look circular on the outside but in reality it is more like a pyramidal structure with four sides and posteriorly, towards the apex it becomes three sided. The thickness of the orbital walls is less than the rim and this makes them predisposed to fracture more as compared to orbital rim. The thickness of the medial orbital wall is the least hence it is most prone to fracture. The inferior orbital canal which is present in inferior orbital wall makes it slightly weak. There are seven bones which make up the orbital structure.
The bony area has the following borders:-
- Base
- Superior wall or the roof
- Medial wall
- Inferior wall
- Apex
- Lateral wall
What are orbital fractures?
Any high intensity impact on the orbital area can cause fractures to the different parts of the orbit. Any fracture that occurs to the orbital area is known as orbital fracture.
Types of orbital fractures:-
Orbital fractures are classified according to the anatomic location they affect. Orbital fractures can affect all the bones of the orbital anatomy. Although the following classification is used for identification of fractures, an individual’s cases is treated and assessed in isolation.
- The fractures that occur in isolation to the orbital roof, orbital floor and medial wall may remain limited to the internal orbital skeleton only. The orbital fractures may follow a blow-in or blow out fracture, the latter may be divided into three categories; lateral blow out fractures which are caused due to very high impact, medial blow out fractures which are caused by intermediate amount of force and trapdoor fractures which are caused by low force.
- Orbital rim fractures: – Fractures of the inferior rim, superior rim or lateral rim can occur on their own or may be accompanied by orbital wall fractures as mentioned above.
- Orbital apex fractures: – They should be detected as soon as possible because they generally are associated with damage of superior orbital fissure and various neurovascular structures.
Symptoms of orbital fractures:-
- Chronic pain eyes
- Orbital Oedema
- Diplopia
- Epistaxis
- Restricted ocular mobility
- Hematoma
- Displacement of globe
- Pupillary dysfunction
Treatment of orbital fractures:-
The treatment for the repair begins with physical examination of the orbital fracture. The treatment for repair involves different scans to ensure that the fracture is not accompanied by any other types of injuries. The treatment and repair plan for repair is completely dependent upon severity of injuries.
- If the fracture is not very severe generally the treatment does not involve repair by surgery. The orbital fracture heals with time.
- If the patient has suffered from severe fracture of the orbital area, an oculoplastic surgeon is called in for the repair.
- A very important aspect of the repair is to ensure that no broken pieces of bones or any torn muscles are not stuck inside the fracture.
- Sometimes, because of the orbital fracture, the eyeball sinks in to the head. In such cases, repair by surgery becomes an important part of the treatment.
Immediate repair of an orbital fracture becomes mandatory in the cases where the fracture cause more than 2mm of enophthalmos and more than half of the orbital floor is fractured. If a CT scan confirm a fracture and the patient’s diplopia is within 30 degrees of gaze a repair should be done shortly after the fracture. Even if these parameters are present in isolation, they indicate an immediate need for repair. Medical therapy is suited for patients in which there is no hypo-ophthalmus, the enophthalmos is less than 2 mm and less half of the floor is fractured.
Surgical approaches used for treatment of orbital fractures:-
The aim of surgery is to preserve the vision of the patients and prevent any disfigurement of the globe of the eye.
Depending upon the location of the orbital fracture, one of the following surgical approaches may be used: –
- Transnasal or Transmaxillary
- Transconjunctival
- Transcutaneous
The number of high- impact road accidents is increasing in India at an alarming rate. Sadly, in metros like Mumbai and Delhi, cases of automobile crashes happen every day. In addition to road accidents, orbital fractures occur because of impactful sports injuries also. For the most part, repair of the orbital fractures can be done easily if there are no anatomical structures involved in the fracture. However, the treatment for repair is complicated because mostly the fracture does not happen in isolation. The repair and treatment for the fractures of the orbit begins with diagnosis so that the exact treatment plan for the repair can be made. Sometimes the treatment plan may not even require repair by surgery. The type of treatment plan that is made for repair of fracture will depend upon the extent of the fracture.
Sometimes after the repair of the fracture the treatment does not end. A reconstructive repair may be required to complete the treatment. An oculoplastic surgeon would be the best choice in this case. This means that the oculoplastic surgeon will not only be able to repair the fracture but also finish off the treatment with the aesthetic restoration of the site of injury.
In India there are only a few oculoplastic surgeons who currently are practicing in the country. One of the top few oculoplastic surgeons of India who is the best in the field is Dr. Debraj Shome. Dr. Debraj Shome is presently based in Mumbai and has his own chain of specialty clinics in Mumbai. His expertise is not only known in Mumbai but all over India. He travels all over India to perform fracture repair surgeries of the patients. Dr. Shome says that the prognosis in the treatment for fractures of the orbit is quite good. Dr. Shome happens to be one of the top surgeons in Mumbai who routinely repairs cases of severe orbital fractures all over India. In India a recent car crash of Mumbai made to newspaper headlines because it was a ‘selfie’ crash. Dr. Shome provided the treatment to the victims in the best way possible and was able to perform the complicated repair. He says that ‘selfie crashes’ are now becoming common in metros like Mumbai.
Dr. Shome is a super specialist and features in the list of the top 10 best surgeons of India. Because of his knowledge which is considered to be the best in his field in India he is routinely called in as visiting surgery faculty in various top hospitals of Mumbai. He is the top expert for orbital fracture repairs and regularly delivers lectures on the same at best medical institutions across India. The no. of oculoplastic surgeons in India is still very less and Dr. Shome is one of the few that are presently practicing in India. Mumbai has shown immense promise in the health care sector and is emerging to be the best center for various health care services in India. In Mumbai, Dr. Shome performs a surgeries and fracture repairs of varying degrees. He says many surgeons in India make the patients go through surgery unnecessarily. Cases of unnecessary surgery being performed on the patients in India are not unheard of. Dr. Shome is considered to be the best in the business because he never does any procedure which is not required. All his clinics in Mumbai enjoy a sparkling reputation because of him and his work ethic. Orbital fractures can be very dangerous and if you are in Mumbai, there is no one better than Dr. Shome to guide you through treatment. Residents of Mumbai can now avail quality healthcare services without any fear of being duped. Many top hospitals of Mumbai are infamous for performing incorrect and unnecessary fracture repair surgeries on innocent patients. But in Mumbai you can completely trust Dr. Shome and his clinics for making your treatment and repair plans as per the proper treatment guidelines only.
