How do you manage periocular reconstructive surgery in patients with advanced orbital fractures and concurrent soft tissue injuries?  

First and foremost is triage - increased intracranial pressure from intracranial bleeding and other life-threatening injuries must first be ruled out, and the patient stabilized. Next, open globe injuries need to be ruled out with a thorough ophthalmic exam, including dilation. Entrapped extraocular...

Assuming the patient is neurologically and hemodynamically stable, soft tissue injuries of the globe must be addressed first. Removal of orbital and intraocular foreign bodies, profuse irrigation, and globe repair, always precedes repair of the orbital fractures. When the fractures warrant repair, i...