What is an eye socket fracture?
The eye socket, or orbit, is made up of the bones that surround the
eye. The structure of the eye socket is designed to protect the eye
from injury. However, if you are injured and the eye or bones around
the eye are hit hard enough, you can break one or more of the bones
around the eye. This is called an eye socket fracture, sometimes
called a blowout fracture.
How does it occur?
An eye socket fracture can result from being hit directly on the eye
or on the bones around the eye. The bones below the eye (the orbital
floor) and between the eye and the nose (the medial wall) are very
thin. When the eye is hit with enough force, the eye itself can
break these bones.
Injuries that can result in an eye socket fracture include:
- falls
- motor vehicle accidents
- sports injuries
- assault (such as a punch or kick to the bones around the eye)
An important type of eye socket fracture is a trapdoor fracture.
This type of fracture usually happens in children because their
bones are springier than those of adults. Because of this
springiness, the bone beneath the eye can swing down when broken and
then swing shut, trapping the muscle that moves the eye down (the
inferior rectus). This causes the muscle to lose blood flow,
resulting in severe double vision, nausea, and vomiting.
What are the symptoms?
Symptoms of an eye socket fracture include:
- decreased vision
- double vision
- pain in and around the eye
- numbness (loss of feeling) in the eyelids, cheek, side of the
nose, upper lip, teeth and gums
- nausea and vomiting (more common in trapdoor fractures)
Signs of an eye socket fracture include:
- bruising and swelling of the eyelids and soft tissue around the
eye
- bleeding and swelling underneath the lining of the eyeball
(called a subconjunctival hemorrhage)
- trouble moving the eye in one or more directions
- the eye appearing sunken in (called enophthalmos)
How is it diagnosed?
Your healthcare provider will ask about your symptoms and your
injury, examine your eyes, and perform tests. Tests you may have
are:
- an exam using a special microscope (a slit lamp) to look closely
at your eye
- an exam with drops and special lenses to look into the back of
your eye (a dilated exam)
- measurements to look at the position of the injured eye compared
with the normal eye
- an imaging scan to look at the bones of the eye socket (called a
computed tomography or CT scan)
How is it treated?
Some eye socket fractures need to be repaired and others do not.
Things that help your healthcare provider decide whether a fracture
needs to be fixed are:
- whether the eye is sunken in
- whether you have double vision and how severe it is
- whether a muscle is stuck between the broken bones
- how large the fracture is, as seen on a CT scan
Eye socket fractures that need repair are fixed with surgery. Some
fractures, such as a trapdoor fracture, need to be fixed right away,
and others may be fixed within a couple of weeks after the injury.
Your healthcare provider may recommend antibiotics to prevent
infections that may be in your sinuses from spreading into the eye
socket. Your provider may also prescribe steroid pills to decrease
swelling in preparation for surgery. You may be asked to avoid
blowing your nose, to sleep with your head elevated, and to avoid
strenuous physical activity before and after surgery.
When you have surgery to repair your eye socket, your surgeon will
make a cut either in the skin of the eyelid or the tissue behind the
eyelid (the conjunctiva) to get access to the broken bone. Pieces of
broken bone may need to be removed. Trapped eye muscles and tissues
from the eye socket are placed back into their normal positions and
the hole in the bone is covered with material to repair the
fracture. You may be observed in the hospital overnight.
When the eye socket was broken, the eye itself also may have been
injured and need treatment.
How long will the effects last?
If your eye socket is treated successfully, and your injury to the
eye or tissues around the eye was not too severe, you may not have
any long-lasting effects from an eye socket fracture. Untreated eye
socket fractures can result in an appearance of the eye being sunk
in and can cause permanent double vision.
How can I take care of myself?
If you are injured and have any of the symptoms of an eye socket
fracture, contact your healthcare provider right away or go to the
nearest emergency room. If you are told you have an eye socket
fracture, ask about the need for repair. Avoid blowing your nose,
sleep with your head elevated and avoid strenuous activities before
and after surgery.
How can I prevent eye socket fractures?
- Always use appropriate eye protection when participating in
sports.
- Seatbelt use, along with airbags, can decrease injuries from
motor vehicle accidents.
Written by Dr. Daniel Garibaldi.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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