ORBITAL TRAUMA
At Eyesthetica, we see and treat orbital trauma. The physicians of Eyesthetica provide 24 hour coverage, seven days a week, to the Eye and Orbital Trauma Center at California Hospital Medical Center in downtown Los Angeles (1401 S. Grand Avenue, Los Angeles, CA 90015, phone 213-742-5555). The Eye and Orbital trauma center is part of the level II trauma center at California Hospital Medical Center. Patients usually come to the Eye and Orbital trauma center if they are brought by ambulance from a trauma scene, suffered loss of consciousness, or sustained a severe eye or orbital injury such as a gun-shot wound.
The center is available for stable transfers of patients with ocular and orbital trauma. Complete eye, ocular adnexa, and orbital services are available, including, but not limited to:
*Ruptured globes
*Corneal or scleral lacerations
*Eyelid lacerations
*Canalicular lacerations
*Facial lacerations
*Orbital fractures
*Retrobulbar hemorrhage
*Corneal, ocular, or orbital foreign bodies
*Periocular trauma
Some patients may sustain orbital trauma without loss of consciousness (such as an elbow to the eye in a basketball game) and thus do not go to the emergency room right away but see their optometrist on an outpatient basis. The patient will usually have swelling and bruising of the eyelids, along with subconjunctival hemorrhage. Depending on the severity of the blow, the patient my also have an iris sphincter tear with traumatic mydriasis, and microhyphema. Extremely rarely, the patient may also suffer a traumatic cataract, vitreous hemorrhage, choroidal rupture, retinal dialysis, or ruptured globe. After ocular examination, an orbital examination is performed. Decreased extraocular motility and binocular diplopia may indicate a fracture of the orbital floor or the orbital medial wall or the decreased motility may be due to merely swelling and contusion of the extraocular muscles. Decreased sensation to touch over the cheek often indicates an orbital floor fracture with trauma to the inferior orbital nerve. If an orbital floor or medial wall fracture is suspected, a CT scan without contrast, axial and coronal views, will confirm the diagnosis. Patients who are seen at the optometrist’s office on an outpatient basis may be referred to Eyesthetica offices on an outpatient basis, rather than through the Eye and Orbital Trauma center.
Orbital floor fractures may or may not need to be repaired. The indications and timing for isolated orbital floor fracture repair have been controversial in the past. We have performed and reported the seminal meta-analysis of all of the articles in the ophthalmology literature. A nonresolving oculocardiac reflex (the patient’s heartrate slows), the "white-eyed" blowout fracture (in children, a “greenstick” fracture of the orbital floor whereby the floor fractured, but popped up again like a trap-down thus trapping tissue causing ischemia), and early enophthalmos or hypoglobus are indications for immediate surgical repair. Surgery within 2 weeks is recommended in cases of symptomatic diplopia with evidence of orbital soft tissue entrapment on CT scan or large orbital floor fractures that may cause enophthalmos. For all other orbital floor fractures, surgical intervention is not needed.
Eyesthetica is the largest private group in the greater Los Angeles area, whose practice is dedicated solely to oculofacial plastic surgery specializing in cosmetic surgery, eyelid reconstruction, lacrimal and orbital surgery. We have opened a new office in Torrance to better serve you and your patients.
Eyesthetica Ophthalmic Plastic & Reconstructive Surgery Oculofacial and Cosmetic Surgery Associates Orbital and Lacrimal Surgery Steven C. Dresner, M.D., Michael A. Burnstine, M.D., Melanie Ho Erb, M.D. Cosmetic Surgery Santa Monica Pasadena Torrance Downtown Los Angeles 310-453-1763 626-564-0004 310-530-9482 213-482-3467 www.Eyesthetica.com