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A softball to the eye, a tumble to the floor, a gunshot wound while hunting, or a wayward fist at a local watering hole all might send a patient to the trauma center with an orbital or ocular injury. In patients with facial fractures, 20 to 25 percent include orbital involvement at some level. Of this group, over 80 percent will include ocular trauma.

"With any of these injuries, it's a matter of energy transfer," says Dr. Viozzi, who has a background in mechanical engineering and notes similarities in vocabulary. "If a person falls, clunks their cheekbone and develops a crack in the orbital floor, energy transferred by the point their face hit the ground was fairly low. You contrast that with a ballistic injury where somebody's been shot in the cheekbone, and there's going to be a lot of involvement of the eye socket, the orbit and the globe itself."

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