An orbital fracture is a condition where one or more bones of the eye socket are broken. The fracture occurs after a blunt trauma to the eye.
Also known as the orbit, the eye socket is the bony cup that holds the eyeball in place. It also houses the nerves, connective tissues and muscles. It is made up of seven bones which vary in thickness. The rim of the socket has a thick structure whereas the floor/inner (medial wall) bones are thin. As such, injuries to the delicate inner walls are more common than those involving the rim.
Also Known As
- Eye socket fracture
- Broken eye socket
Orbital rim fracture – This is a less common fracture involving the rim (outer edge) of the eye socket. For an orbital rim to break, extreme force is required. The fracture commonly occurs with other injuries which involve the facial bones or even the brain. When limited to the eye region, the optic nerves, tear ducts, eye muscles or sensory nerves may be affected.
Blowout fracture - It is also referred to as indirect floor fracture. Usually, the floor of the eye, a paper thin structure cracks while the rim remains unaffected. The cracked floor may trap the eye muscles and other structures, limiting the movement of the eye. Most blow fractures happen when an object bigger than the size of the eye opening hit the front part of the eye. They are the most common of eye socket fracture cases.
Orbital floor fracture - This is where the fracture extends to the floor of the eye socket. It is likely to occur after severe trauma.
Causes and Risk Factors
Any impact on the eye by a blunt object such as a baseball, hammer, furniture, or stair can cause the bones to break. In some instances, the fractures may be caused by car crashes or other high-impact situations. While most cases are attributed to accidental injuries, physical assaults and fights are also possible causes of orbital fractures. Young children and men are at a higher risk of obtaining orbital fractures.
Signs & Symptoms
In mild cases, the signs and symptoms of an eye socket fracture may include:
- Bruising around eye – The injured eye will usually have a surrounding black or blue discoloration
- Bleeding – There may be blood in the white part of the eye due to ruptured vessels
- Swelling beneath the skin of the eyes
In severe cases, the individuals may experience symptoms such as:
- Numbness in some parts of the face
- Difficulty in moving the eye
- Pain in the cheeks when opening the mouth
- Sunken or protruding eyeballs
- Double vision
For conscious individuals, the eye care professional may ask a few questions concerning the injury. He/she will then examine the eye to assess the following:
● Numbness on the injured part of the face
● Movement of the eyes – The patient will be asked to look upwards, downwards and sideways. Any limitation in movement could indicate trapping of the eye muscles
● Vision changes – Double vision is a sign that the eye socket could be fractured.
● Internal damages – An ophthalmoscope will be used to check for any damages inside the eye. An X-ray or CT scan around the eye can be used to confirm the diagnosis. The imaging tests are especially important when dealing with unconscious patients.
Treatment is based on severity and location of the fracture. It focuses on relieving the symptoms, reverting damage and quickening the healing process.
Not all orbital fractures require medication or repair to heal. The doctor first assesses the level of damage and monitors the progress for a few weeks. A few drugs, including oral antibiotics, steroids, and painkillers may be issued to treat infections, pain and inflammation. Decongestants can also be prescribed to clear the sinuses of blood and fluid.
Plastic and reconstructive surgeries are performed in severe cases. The operation focus may be to:
- Remove bone fragments inside the eye
- Correct double vision by freeing trapped eye muscles
- Restore the normal architecture of the eye (where the eyes are bulging or sunken)
- Repair facial deformities linked to the fracture that affects appearance
For faster healing, patients can apply ice packs on the injured eye. The remedy helps to ease the pain, swelling, and discoloration. It is also recommended that patients avoid blowing their nose during the healing period.
The prognosis for orbital fractures is usually good. Treatment is not always necessary. For most patients, the swelling and discoloration clears in about 7 to 10 days. The double vision can also resolve on its own without any medical interventions. There are rarely any complications associated with surgery for the orbital fractures.