An orbital fracture is a break in one or more of the bones that form your eye socket, the cup-shaped cavity in your skull that holds and protects your eyeball. Seven bones make up each eye socket: the frontal, ethmoid, lacrimal, sphenoid, zygomatic, palatine, and maxilla. Some of these bones are paper-thin, which is why a punch, a baseball, or even a fall can crack them.
Types of Orbital Fractures
Not all orbital fractures are the same. The type depends on which part of the socket breaks and how much force caused it.
A blowout fracture is the most common type. It happens when something strikes your eye or the area around it, and the force breaks through the thin floor or inner wall of the socket without damaging the thick outer rim. A fist or a ball hitting the eye is the classic cause. When the floor breaks, the tissue and small muscles that help move your eye can slip downward into the sinus cavity below, which is what causes many of the symptoms.
Orbital rim fractures affect the thick outer edges of the socket. Because this bone is dense and strong, it takes serious force to break it. Car accidents are the most common cause. If the rim is fractured, other facial bones are almost always broken too.
Orbital floor fractures happen when an impact pushes the rim bones backward, causing the thinner floor bones to buckle downward. These fractures tend to affect the nerves and muscles around the eye, limiting how well it can move.
How the Bone Actually Breaks
Researchers have proposed three main ways a blowout fracture occurs. The “hydraulic” theory says that a blow compresses the eyeball, which increases pressure inside the socket and blows out the weakest wall. The “globe-to-wall” theory suggests the eyeball itself gets pushed backward and directly contacts the thin floor or wall. The “bone conduction” theory proposes that force travels through the rim bones and concentrates at the thinnest points, cracking them. In reality, most fractures likely result from a combination of two or more of these mechanisms working together.
Symptoms to Recognize
Some signs are obvious, others are easy to miss. Common symptoms include:
- Double vision, especially when looking up. This happens because the muscles that move your eye get trapped or swollen in the fracture line.
- Restricted eye movement, particularly upward gaze. Your eye may physically not be able to look in certain directions.
- Numbness along your cheek, upper lip, or the side of your nose. A nerve that runs along the orbital floor supplies sensation to this area, and a fracture can damage it.
- A sunken-looking eye. Called enophthalmos, this happens when broken bones allow the eyeball to sink deeper into the socket.
- Swelling and bruising around the eye, sometimes severe enough to prevent you from opening it.
Pain, headache, and dizziness are also common. In some cases, the eye itself may be visibly bulging outward instead of sinking inward, depending on how the bone fragments shift.
Why It Looks Different in Children
Children’s bones are more flexible than adult bones. Instead of shattering, the orbital floor in a child often bends like a trapdoor, snapping back into place after the tissue slips through. This creates what’s called a “white-eyed blowout fracture,” named because there’s little or no visible bruising or swelling. The eye looks normal on the outside, which makes the fracture dangerously easy to miss.
The problem is that the trapdoor snaps shut on the muscle or tissue, trapping it tightly. Children with this injury may complain only of vague pain rather than double vision. Some develop nausea, vomiting, and a slowed heart rate from a reflex triggered by pressure on the trapped muscle. This is treated as an emergency because delaying surgery can lead to permanent double vision, restricted eye movement, or even muscle death from lost blood supply. Better outcomes are consistently linked to earlier release of the trapped tissue.
How It’s Diagnosed
A CT scan is the primary tool for diagnosing orbital fractures. It’s fast and excellent at showing bone detail, and three-dimensional reconstructions can map exactly where and how large the break is. Standard X-rays can miss smaller fractures, so CT is preferred whenever an orbital fracture is suspected.
On the scan, doctors look at several things. A fracture involving more than 1 square centimeter, or more than 50% of the orbital floor, generally indicates a break large enough to need repair. They also check whether the muscle that controls downward eye movement has changed shape. If it appears rounded instead of flat on the scan, it suggests the supporting tissue has been disrupted, making a sunken eye more likely over time. MRI is occasionally used when soft tissue damage needs closer evaluation or when a foreign object made of organic material (like wood) is suspected, since CT can miss those.
When Surgery Is Needed
Not every orbital fracture requires surgery. Small fractures without muscle trapping or significant bone displacement often heal on their own with conservative care. The decision to operate typically comes down to a few key factors: whether eye muscles are trapped in the break, whether the fracture is large enough that the eye will likely sink over time, and whether double vision persists after swelling goes down.
When surgery is needed, timing matters. For fractures with confirmed muscle entrapment, repair happens quickly, averaging under two days in one review of surgical cases. In about a third of cases, the decision to operate is based on fracture size alone, even without current symptoms, because a large enough defect is expected to cause a sunken appearance as healing progresses. For less urgent cases, surgeons often wait a week or two to let swelling resolve before reassessing.
What Recovery Looks Like
For fractures managed without surgery, most of the healing happens over four to six weeks as the bone knits together. Swelling and bruising typically improve within the first one to two weeks. Numbness along the cheek can take weeks to months to resolve, and in some cases it becomes permanent if the nerve was significantly damaged.
After surgery, the recovery timeline is similar for the bone itself, but there are additional considerations. Surgeons often place a small implant to reconstruct the orbital floor, and potential complications include infection of that implant, implant shifting, worsening double vision, lower eyelid pulling downward, and in rare cases (occurring in roughly 0.2% to 0.4% of surgeries), bleeding behind the eye that can threaten vision.
One important rule during recovery: do not blow your nose. The orbital floor sits directly above the sinus, and blowing your nose can force air from the sinus up through the fracture and into the tissue around your eye, causing sudden swelling and potentially introducing bacteria. Sneezing with your mouth open, avoiding straining, and sleeping with your head slightly elevated all help reduce pressure in the area while the bone heals.