Orbital Fractures

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What Does Having an Orbital Fracture Mean?

The eye socket is the bony cup that contains the eyeball and the appendages that support and protect it. The rim of the socket is constructed of bones that are moderately thick, while its floor and nasal side are as thin as a sheet of paper in many places. A broken bone in any part of the eye socket is known as an orbital fracture.

Types of Orbital Fractures

The most common orbital fractures are orbital rim, indirect orbital floor, and direct orbital floor.

Orbital rim fracture

The outer rim is the thickest part of the eye socket, and a great deal of force is required to break it.

Orbital rim fractures are the result of a severe direct impact to the face, i.e., during an automobile crash in which the steering wheel, dashboard or other hard surface collides with the face. Additional injuries to the eye itself are not uncommon; the optic nerve, eye muscles, nerves in the cheek and forehead, and the sinuses surrounding the eye and the tear duct are often damaged. Because of the immense force required to cause such a fracture, extensive injuries to other facial bones, the optic nerve, and even the brain are possible.

Air bags and laws requiring the use of seat belts have decreased automobile eye injuries significantly.

Indirect orbital floor fracture (known as “blowout”)

In this type of fracture, the bony rim of the eye remains intact, but a rupture or crack of the thin floor of the eye socket creates a small hole that can entrap parts of the eye muscles and nearby structures; when this occurs, the injured eye may not move normally in its socket, sometimes resulting in double vision. Most blowout fractures are caused by an impact to the front of the eye from something larger than the eye opening, e.g., a ball used in sports, a fist or the dashboard of a vehicle.

Direct orbital floor fracture

Fractures of the orbital floor are commonplace, its delicate anatomy predisposing it to damage.

A direct orbital floor fracture extends into the lower socket, damaging both the rim and floor of the eye. This injury is usually caused by a harsh blow with a blunt object, e.g., a hammer, piece of wood, hard ball, or rock.

How Do You Know if You Have an Orbital Fracture?

The symptoms of an orbital fracture vary, depending on where the fracture is located and its severity. Symptoms may include:

  • Discoloration, black and blue surrounding the injured eye and redness/bleeding on the white of the eye
  • Double, decreased, or blurry vision
  • Difficulty looking right, left, up, or down
  • Numbness in forehead/eyelids/ cheek, upper teeth, or lip
  • Irregular position of the eye, i.e., bulging out of or sunken into the socket
  • Puffiness of skin near the eye
  • Deformity/swelling of the forehead or cheek
  • Uncharacteristically flat cheek
  • Severe cheek pain when opening your mouth

Treating an Orbital Fracture

Treatment for an orbital fracture will depend on its location and severity of your injury.

For a minor “blowout” fracture that does not affect your eye’s movement, ice packs, rest, an antibiotic to prevent infection, and decongestants may be all that is needed.

Bone fragments, double vision, or injury that affects the structure and/or appearance of your eye and its surrounding area may require surgery. If your case is acute, you will likely be referred to a plastic/reconstructive surgeon trained specifically in eye trauma, and an ophthalmologist, a physician trained in treating disorders/diseases of the eye.

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