Blows on the side of the cheek and across one or other eye occur in fights, industrial accidents and road traffic accidents. The most common type is the "blow-out fracture". Here the globe and contents of the orbit are forced backwards, causing fracture of the orbital floor and displacement of bone downwards into the antrum of the maxillary sinus. The inferior rectus muscle becomes tethered in the wound so that there is mechanical limitation of upward movement. The infraorbital nerve, which traverses the orbital floor, can also be injured, producing anaesthesia of the skin of the cheek. Once the surrounding swelling has subsided, the posterior displacement of the globe becomes obvious and the globe of the eye itself often shows evidence of contusion. A considerable improvement from the functional and cosmetic point of view can be obtained by positioning a plastic or Teflon implant in the floor of the orbit after freeing the prolapsed tissue.
Fractures of the skull that extend into the orbit can be accompanied by retro-orbital haemorrhage and proptosis. Cranial nerve palsies affecting the ocular movements are also commonly seen in this type of injury and the vision can be affected by optic nerve damage. A blow on the eye can result in sudden blindness with at first no other evidence of injury (apart from an afferent pupillary defect), but subsequently, the optic disc becomes pale and atrophic after two or three weeks.
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