Fractures and cracks in the bones of the orbit.

Fractures and cracks in the bones of the orbit are found in both large and small farm animals, but most often they are observed in horses. There were cases of fractures and cracks in the supraorbital process and the frontal bone, malar, temporal and tear bones. Fractures of the supraorbital process of the frontal bone are most often recorded.

Etiology. The causes are mechanical influences, for example blows with sharp and blunt objects, falls. In small animals, injuries are often observed when falling under motor vehicles, etc. By the nature of the lesions, open and closed, simple and fractured fractures are distinguished.

Clinical signs. Ophthalmic fractures are accompanied by severe swelling and infiltration with connective tissue blood, inflammatory edema of eyelids and conjunctiva, and often hemorrhages. On the periphery of the cornea, diffuse opacities are usually observed. At first the picture is not clear, especially as research is hampered because of severe edema and great soreness. Rapid development of edema indicates a hematoma. Inflammation is accompanied by swelling of the tissues: they acquire a doughy or dense consistency. After the first phase of inflammation, the fracture is diagnosed by the crepitation of fragments of bones. Fracture of the upper edge of the orbit is most easily revealed by the mobility of the broken part and its typical deformation. It is comparatively easy to establish a fracture of the frontal process of the malar bone and the malar bone of the temporal bone. Cracks in orbital bones are difficult to diagnose; in this case, it is advisable to resort to an x-ray. With significant bone displacements, the eyeball may fall out or protrude outward.

 

Pathogenesis. The course of the process depends on the severity of the injury, infection with microflora, whether the eyeball and the optic nerve are damaged. If the nerve is damaged, vision may be lost. With open injuries, it is also dangerous to communicate with subclavial cavities and the brain cavity. When infection develops retrobulbar phlegmon and even panophthalmitis. In the case of simple fractures (without bone displacement), healing can occur quickly, especially in young animals. Treatment. With closed fractures, anti-inflammatory therapy is shown: first as a cold to limit inflammation, and starting from 2 days, heat is used to speed up resorption of the inflammatory exudate and healing. With open fractures, it is first necessary to thoroughly clean the wound, remove the fragments of bones, then prescribe antiseptic agents. In both cases, animals are given peace. Horses are kept on a short leash; dogs to prevent scratching, put on a cervical collar or apply an eye patch. With the development of purulent inflammation, sodium sulfacil is used, antibiotics, in order to avoid the spread of infection, resort to extensive dissection, removal of the eyeball or exenteration of the orbit.

Phlegmon of the orbit.  This is a diffuse purulent inflammation of the orbital fiber. 

Etiology.  Most often phlegmon occurs as a result of deep damage to the conjunctiva and the skin around the orbit, especially the supraorbital fossa, and also pressure sores. It is observed much less often when the inflammatory process passes from surrounding tissues or carries the infection by the hematogenous way, for example, in sepsis and other purulent diseases, periodontitis, panophthalmitis. If the blood vessels of the orbit are damaged, a hematoma is formed, which subsequently becomes infected. Initially purulent process can develop extraorbital, but then it spreads to tissues enclosed in periorbital, that is, becomes retrobulbarnym. 

Clinical signs. A characteristic feature is a strong edema that spreads to the eyelids, the temporal region and further to the ear and even to another eye. The eyelids swell so much that the eye gap seems completely closed and the edges of the eyelids protrude outward. Edema passes to the conjunctiva of the eyelids, and the latter also protrudes outward (chemosis). The local temperature of the eyelids is increased. At palpation note strong soreness. Supraorbital fossa is aligned. The eyeball loses its mobility and protrudes due to the swelling of the retrobulbar space. Conjunctiva red, its surface is covered with purulent exudate. The latter is initially a liquid consistency and drains down, and then becomes gelatinous; they detect purulent-fibrinous plaque. The cornea becomes turbid, marking the desquamation of the epithelium with the formation of erosions and ulcers. Investigation of the eyeball is difficult.

The general condition of the animal is depressed, appetite is lowered, body temperature is increased, vision is weakened. Observe increased lacrimation, photophobia; when examining the fundus, anemia is detected, often edema of the optic nerve disk, and then its atrophy. In the study of blood as the development of the inflammatory process, neutrophilia is noted with a shift of the nucleus to the left. Spontaneous recovery is a rare occurrence of an abscess, which is then opened in the conjunctival sac or on the skin of the eyelid, in the supraorbital cavity. It is necessary to distinguish the phlegm of the orbit from the panophthalmitis, in which the purulent inflammation of all parts of the eyeball is observed with the accumulation of pus in the anterior chamber.

Pathogenesis. The pathogenic microflora causes phlegmonous inflammation of the orbital fiber inside the periorbital between the fascia of the eye; in the future, tissues are destroyed and an abscess is formed. Pus can penetrate into the eyeball, causing purulent choroiditis, panophthalmitis and even inflammation and atrophy of the optic nerve. Through the perivascular spaces in the sclera and the vagina of the optic nerve, pus can spread to the cerebral cavity, which will lead to meningitis and encephalitis. The course of the disease is acute. Rarely the process ends with resorption, most often an abscess is formed, after the opening of which and with the appropriate treatment, recovery comes with the restoration of vision. 

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