An orbital fracture is a break in one or more of the bones that form the eye socket. The socket (called the orbit) is a cone-shaped structure made up of seven different bones, and a fracture to any of them can affect how the eye moves, how it looks, and in severe cases, how well you can see. These fractures most commonly involve the orbital floor, the thin shelf of bone that sits between your eye and the sinus cavity below it.
Bones That Make Up the Eye Socket
The orbit has four walls, each formed by a different combination of bones. The roof is made of the frontal bone (your forehead) and part of the sphenoid bone deeper in the skull. The outer wall is formed by the cheekbone and another wing of the sphenoid. The floor sits on three bones: the cheekbone, the upper jawbone, and a small piece of the palatine bone. The inner wall is the most complex, involving four bones, including the ethmoid bone.
Two areas are especially vulnerable. The orbital floor is the most commonly fractured wall because the bone there is thin and sits directly above a hollow sinus. The inner (medial) wall is also fragile. The ethmoid bone contains a section called the lamina papyracea, which translates roughly to “paper-thin plate,” and that’s an accurate description. A strong enough impact to the front of the face can crack either of these walls even when the thicker rim of the socket stays intact.
Types of Orbital Fractures
Not all orbital fractures look the same on a scan, and the type determines how serious the injury is and whether surgery is needed.
- Blowout fracture: The most common type. The bony rim of the socket stays intact, but the thin floor or medial wall breaks inward. This often happens when something roughly the size of a fist or a ball strikes the eye area, suddenly increasing pressure inside the socket. The force “blows out” the weakest wall, typically sending bone fragments and soft tissue downward into the sinus below.
- Orbital rim fracture: A break along the thick outer edge of the socket. This requires more force than a blowout fracture because the rim is much stronger. These injuries often result from car accidents or high-impact falls.
- Complex (tripod) fracture: A break that involves the cheekbone and multiple walls of the orbit at once, often fracturing in three places simultaneously. These are more severe injuries that can change the shape of the face.
Symptoms to Recognize
The signs of an orbital fracture usually show up right away. Swelling and bruising around the eye are nearly universal. Beyond that, the specific symptoms depend on how much the bone shifted and whether soft tissue got caught in the break.
Double vision is one of the hallmark symptoms. When the orbital floor breaks, the soft tissue and muscles around the eye can herniate (push through) the gap into the sinus below. If the muscle that controls upward and downward eye movement gets trapped in the fracture, the eye can’t track normally. You’ll typically notice double vision when looking up or down. Less commonly, it shows up when looking straight ahead or side to side.
Numbness in the cheek, upper lip, or teeth on the injured side is another common sign. A nerve runs along the orbital floor, and a fracture there can damage or compress it, causing tingling or a loss of sensation. Some people also notice air trapped under the skin around the eye (it feels crackly to the touch), which happens when the fracture opens a path between the sinus and the tissue around the socket.
The eye itself may look different. In the first few days, swelling can push the eye slightly forward. Once swelling goes down, the opposite problem can emerge: if the fracture created a large enough gap in the floor, the eye can gradually sink backward and downward into the socket, a condition called enophthalmos. This sunken appearance can worsen over time if the fracture isn’t repaired.
How Orbital Fractures Are Diagnosed
A CT scan is the standard tool for confirming an orbital fracture. Regular X-rays can miss smaller breaks, especially in the thin floor and medial wall. CT scanning offers the highest confidence for identifying these injuries, particularly when the images use thin slices of 3 millimeters or less to capture the fine bony structures of the face.
Doctors typically need images from multiple angles. Coronal views (slicing front to back, like looking at the face head-on) give the best picture of the floor and roof. Axial views (slicing horizontally) are better for evaluating the inner and outer walls. Together, they show the size of the break, whether bone fragments have shifted, and whether soft tissue has herniated through the gap.
When Surgery Is Needed
Many orbital fractures heal on their own with conservative care. Surgery becomes necessary in specific situations, though the exact criteria can vary between surgeons.
The clearest reason for surgery is muscle entrapment. If double vision persists 10 to 14 days after the injury, with imaging confirming that tissue is trapped in the fracture, surgical release and repair is typically recommended. Double vision that occurs within 30 degrees of your straight-ahead gaze is another strong indicator, since this range of vision matters most for daily activities like reading and driving.
Fracture size also matters. When more than half of the orbital floor is broken and tissue has prolapsed through the gap, significant sinking of the eye (greater than 2 millimeters) usually follows. Even a fracture involving a third or more of the floor often leads to noticeable cosmetic or functional problems. If enophthalmos of more than 2 millimeters is still present 10 to 14 days after the injury, that’s generally considered cosmetically significant enough to warrant repair.
Surgery involves lifting the herniated tissue back into the socket and placing a thin implant over the fracture to reconstruct the orbital floor. Surgeons can often access the fracture through an incision hidden inside the lower eyelid or just below the lash line.
Recovery and Long-Term Outlook
For fractures that don’t require surgery, recovery focuses on managing swelling and protecting the healing bone. You’ll be told not to blow your nose for several weeks, since the fracture connects the eye socket to the sinus, and the pressure from nose-blowing can force air into the tissue around your eye or displace healing bone. Ice packs, sleeping with your head elevated, and avoiding strenuous activity are standard recommendations in the first week or two.
Most uncomplicated orbital fractures heal well, but some effects can linger. Nerve pain from damage to the nerve running along the orbital floor can persist for up to nine months. Some people experience persistent double vision after surgical repair and may need a second procedure. Enophthalmos can also worsen over time rather than improve, particularly if the initial fracture was large and went unrepaired. For these reasons, follow-up visits that include eye movement testing and careful measurement of eye position are important in the weeks and months after the injury.