Clinical Review Lesson of the week

Orbital trauma: do not blow your nose

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7190.1054 (Published 17 April 1999) Cite this as: BMJ 1999;318:1054
  1. G N Shuttleworth, registrar in ophthalmologya,
  2. D B David, fellow in orbital/oculoplasticsa,
  3. M J Potts, consultant in ophthalmologya,
  4. C N Bell,, senior dental officerb,
  5. P G Gues, consultant in maxillofacial surgeryb
  1. aBristol Eye Hospital, Bristol BS1 2LX
  2. bDepartment of Oral and Maxillofacial Surgery, Bristol Dental Hospital, Bristol BS1 2LX
  1. Correspondence to: Dr Shuttleworth
  • Accepted 8 August 1998

Patients with proved or suspected orbital or sinus fractures should be told not to blow their nose and should be prescribed prophylactic antibiotics

Orbital infections may be divided into preseptal cellulitis, in which infection is located anterior to the orbital septum (a thin sheet of fibrous tissue arising from the periosteum of the orbital margin and inserting into the tarsal plates), and orbital cellulitis, in which there is infection of orbital tissues posterior to the orbital septum. Preseptal cellulitis generally responds to oral antibiotics and rarely has important sequelae. However, orbital cellulitis is a serious infection which may be complicated by abscess formation (subperiosteal, orbital, or brain), meningitis, septicaemia, cavernous sinus thrombosis, and death. Although orbital cellulitis is related to ethmoid sinusitis in 70-80% of cases,1 it may also develop after orbital or sinus trauma. 2 3Prompt and appropriate management of patients with orbital cellulitis or at risk of developing this minimises the risk of complications.

Case history

A 16 year old girl attended her local casualty department after sustaining a blow to the right side of her face. Facial radiography showed a minimally displaced fracture of her right zygoma. She was sent home and told to report three days later to the Bristol …

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