W. Va. Code R. § 85-20-31

Current through Register Vol. XLI, No. 45, November 8, 2024

Section 85-20-31 - Treatment Guidelines: Orbital Fracture

31.1. Fractures of the orbit may be indirect, resulting in a "blowout" of the orbital floor or medial wall, or direct involving fractures of the orbital rims.

31.2. The appropriate diagnostic criteria consists of a history of blunt trauma to the eye, usually by an object larger then the bony orbital opening. The eye may appear proptosis or enophthalmic. Ocular motility is usually diminished. There is usually numbness over the cheek due to injury to the infraorbital nerve. There may be a palpable fracture of the orbital rim. There may also be a fracture of the zygomatic arch.

31.3. The appropriate diagnostic tests and examinations are as follows:

a. A comprehensive examination by an ophthalmologist is necessary, including a visual acuity, slit lamp examination and dilated fundus examination;

b. X-ray of the orbits; and

c. Coronal CT scans.

31.4. Appropriate treatment is as follows:

a. In uncomplicated cases outpatient treatment is appropriate and consists of the following:

1. Outpatient follow-up for 1 - 2 weeks;

2. Oral antibiotics; and

3. Analgesics may be required.

b. Inpatient treatment is appropriate for severe fractures or other complicated injuries. Treatment consists of the following:

1. Surgical repair;

2. Medications include antibiotics and analgesics; and

3. Hospitalization from 1 - 3 days.

31.5. The estimated duration of care is as follows:

Diplopia may resolve spontaneously within one to two weeks with small fractures not requiring repair. Double vision generally resolves within two to three weeks after surgical repair unless there is intrinsic damage to the extraocular muscles.

Modified work may be required with diplopia resolved. Heavy work can generally be resumed three weeks after injury if surgery is not required, or three weeks after surgical repair.

31.6. The anticipated outcome is resolution of diplopia and normal functioning of the eye. Numbness over the cheek may persist for one year or longer and is not affected by surgical repair.

W. Va. Code R. § 85-20-31