Management of orbital-cranial trauma.

Orbital-cranial injuries have the greatest potential for death and disability of any condition treated by the ophthalmologist. An object that penetrates through the orbit into the brain may leave only a small entrance wound. Patients can have normal vision, neurologic exam, and plain x-rays despite trauma that may lead to meningitis, brain abscess, or pneumocephalus. The CT scan greatly aids in both the early and late management of blunt and penetrating orbital-cranial trauma. The detection of pneumocephalus may be the only clue that intracranial penetration has occurred. Blunt trauma can cause vision loss, ophthalmoplegia, ptosis, and intracranial injury. Management of orbital-cranial trauma frequently requires a team approach by the ophthalmologist and neurosurgeon due to the complexity of these injuries.