Emphysema

In cases of fracture involving the inner wall and opening up the nasal cavities or sinuses the air, particularly in blowing the nose, may be forced into the orbit, distending the lids and producing a peculiar crackling sensation when palpated. No treatment directed to removal of the air is necessary. It is valuable as a diagnostic sign of fracture communicating with the nasal cavities.

Fig.92.   The edges of the incised periosteum have been separated and the external rectus muscle divided, exposing the space posterior to the bulb. (Kronlein's operation for obtaining access to the retrobulbar region).

Fig.92. - The edges of the incised periosteum have been separated and the external rectus muscle divided, exposing the space posterior to the bulb. (Kronlein's operation for obtaining access to the retrobulbar region).

Hemorrhage

Hemorrhage into the orbit may occur either as the result of direct traumatism involving the contents, or from fracture of the base of the skull through the orbital plate. The blood pushes its way anteriorly and shows itself under the conjunctiva surrounding the cornea. It is prevented from appearing on the lids by the orbitotarsal ligament. A subconjunctival hemorrhage alone is not sufficient to justify a diagnosis of fracture of the base of the skull, although it is a significant confirmatory symptom.

Kronlein's Operation

In order to gain access to the back part of the orbit to remove tumors, Kronlein resects the outer wall, divides the periosteum and external rectus muscle, and so gains access to the retrobulbar space. The various steps of the operation are shown in Figs. 90, 91, 92.