Observation

Observation may be indicated in slightly or nondisplaced orbital floor fractures without significant disturbance of eye mobility, when there is a minor disturbance that might resolve spontaneously, or when changes in orbital volume are not significant.

Observation may also be considered in an orbital fracture of the only seeing eye or if the patient's condition does not allow surgical intervention.

The decision to observe rather than to carry out surgery is based on thorough evaluation. Correction of a potential secondary deformity is extremely challenging.

The image shows a coronal slice (bone window) of an isolated minimally displaced left orbital floor fracture with minimal volume change.

Due to periorbital edema following trauma, most patients may initially present with proptosis. Despite this early presentation, enophthalmos or dystopia may become apparent when the edema has resolved after approximately two weeks.

The patient must be examined and reassessed regularly.

Additionally, an ophthalmological evaluation is always indicated. If any disturbance of eye mobility or globe position develops, CT re-examination (and in particular circumstances, an MRI examination) may also be indicated, and operative treatment becomes necessary.

The image shows a sagittal slice from the same patient demonstrating the fracture in the orbital floor.

The patient should be observed until all symptoms have fully resolved and the chances of developing late sequelae are unlikely.