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 the bones around the eye are hit hard enough, they can break. This is called an orbital fracture.

What is the cause?

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. This causes the muscle to lose blood flow, resulting in pain, 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 under the surface of the white part of the eye
• trouble moving the eye in one or more directions
• the eye may bulge out or be sunken in

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 check the position of the injured eye compared with the normal eye
• a CT scan to look at the bones of the eye socket and to look for blood behind the eye

How is it treated?

Some eye socket fractures need to be repaired and others do not. Your healthcare provider decides whether a fracture needs to be fixed based on:

• 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 prescribe antibiotics to prevent sinus infections from spreading into the eye socket. Your provider may also prescribe steroid pills to decrease swelling before surgery. You will 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 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 stay in the hospital overnight.

If your eye was injured when the eye socket was broken, your eye also may 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. After the injury, the eye sometimes appears to bulge forward because of swelling of the tissue behind the eye. If an eye socket fracture is not treated, however, the eye may eventually look sunk in. You may also have double vision for the rest of your life.

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. Avoid strenuous activities before and after surgery. Also avoid blowing your nose and sleep with your head elevated.

How can I prevent eye socket fractures?

• Wear proper sports eye guards and face masks when you play sports or participate in activities such as paintball.
• Wear seatbelts to decrease injuries from car accidents. Airbags also help prevent injury.