A broken orbital bone, or orbital fracture, is an injury to the bony socket that surrounds and protects the eye. The orbit is a complex structure made up of seven different bones that form a protective shell for the eyeball, muscles, nerves, and fat. Since the orbit is relatively strong, a fracture typically results from significant blunt force trauma to the face or eye area. Although the eye itself may appear undamaged, a break in the bony housing can cause serious functional problems by affecting the tissues contained within the socket.
Anatomy and Types of Orbital Fractures
The bony orbit resembles a four-sided pyramid, with the base facing forward and the tip pointing toward the back of the head. The orbital rim, which forms the outer edge of the socket, consists of the thickest bone and requires substantial force, such as from a car accident, to fracture. Fractures involving this robust rim are known as Orbital Rim Fractures and are often associated with other facial or head injuries.
The inner walls and floor of the orbit are considerably thinner, making them susceptible to fracture even when the rim remains intact. A common type is the Blowout Fracture, which happens when pressure from an object hitting the eye socket causes the thin bone of the floor or medial wall to break inward. This fracture pattern often results in the partial herniation of orbital contents, such as fat or eye muscles, into the adjacent sinuses. The inferior wall, or orbital floor, is the most frequently fractured area, often caving into the maxillary sinus below.
Recognizing the Symptoms
Symptoms of a broken orbital bone are directly related to the structures damaged or displaced by the break. One of the most common signs is pain and swelling around the eye, often accompanied by bruising, known as a black eye. If the fracture extends to the cheekbone area, the cheek and forehead can also appear swollen or flattened.
A significant functional symptom is double vision, or diplopia, which occurs when the eye muscles become restricted or trapped in the fracture site. For example, a blowout fracture of the floor can trap the inferior rectus muscle, making it difficult or impossible to move the eye upward, leading to double vision that is worse when looking in certain directions. Patients may also experience numbness or a tingling sensation (paresthesia) in the cheek, upper lip, or gums. This symptom is caused by damage or compression to the infraorbital nerve, which runs along the orbital floor.
In some cases, the eye may appear to sink back into the socket, a condition called enophthalmos, due to the loss of bone support and the displacement of soft tissue into the sinus. This sunken appearance may become more noticeable as initial swelling subsides. Difficulty moving the eye, reduced visual acuity, or persistent double vision should prompt immediate medical attention.
Diagnosis and Immediate Medical Steps
Assessment of an orbital fracture begins with a thorough physical examination focused on the eyes and surrounding structures. A healthcare provider will check the patient’s visual acuity, test eye movement in all directions, and look for signs like numbness or a change in the eye’s position.
To confirm the presence and extent of the fracture, imaging is necessary, with a Computed Tomography (CT) scan being the preferred diagnostic tool. A CT scan provides detailed cross-sectional images of the bone and soft tissues, which is essential for visualizing the fracture lines, measuring the size of the defect, and identifying any muscle entrapment. Specialized views, such as coronal cuts, are often requested to better evaluate the integrity of the orbital floor.
Immediate self-care steps following the injury are focused on minimizing complications and controlling swelling. Patients are typically advised to apply ice packs to the area to reduce swelling and to avoid blowing their nose. Blowing the nose can force air from the sinuses through the fracture site into the orbit, causing a painful condition known as orbital emphysema. In some instances, antibiotics or nasal decongestants may be prescribed to prevent infection or help keep the sinus passageways clear.
Treatment Options and Recovery
Treatment for a broken orbital bone involves either observation or surgical repair, depending on the severity of the injury and resulting symptoms. Many small, non-displaced fractures that do not cause vision problems, significant double vision, or muscle entrapment can be managed without surgery. Non-surgical management involves careful monitoring by an ophthalmologist, rest, and restricted activity to allow the bone to heal naturally over time.
Surgical repair is generally required when the fracture is large, when the eye muscle is trapped and causing persistent double vision, or when the eye has sunken noticeably into the socket. The goal of surgery is to release any trapped tissue, reconstruct the bony defect, and restore the proper volume of the orbit. During the procedure, surgeons often use small, thin implants to cover the area where the bone is missing, effectively patching the floor or wall.
Surgery is often delayed for one to two weeks to allow severe swelling to subside, which leads to better surgical outcomes and more accurate assessment. Studies suggest that performing the repair within 14 days of the injury is associated with a reduced incidence of long-term double vision and enophthalmos. Recovery involves avoiding heavy lifting, strenuous activity, and contact sports for several weeks to prevent disruption of the repair. Follow-up care focuses on resolving any residual vision issues and monitoring the long-term stability of the eye’s position.