Eye Socket Fracture (Orbital Fracture)

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.