A blow-out fracture is an injury to the bones forming the eye socket, also known as the orbit. It occurs when sudden, direct pressure on the eye transmits force to the socket walls, causing the thin bones of the floor or inner wall to break. The orbital floor bones are particularly thin and can buckle under this pressure, which may help protect the eyeball from a more severe injury.
Causes and Symptoms
A blow-out fracture is caused by blunt force trauma from an object larger than the eye socket, such as a fist, a baseball, or a steering wheel. The impact creates a sudden increase in pressure within the orbit, causing the thin bones of the eye socket floor or inner wall to fracture as they absorb the force.
A common sign of a blow-out fracture is bruising and swelling around the eye, often called a “black eye.” Patients may also experience double vision, medically termed diplopia, which can be more pronounced when looking in certain directions. This occurs if the muscles that control eye movement become trapped in the fractured bone fragments.
Another symptom is numbness in the cheek, upper lip, and gums. This happens if the nerve that provides sensation to these areas, which runs along the floor of the orbit, is damaged during the fracture. The appearance of the eye can also change. The eyeball may look sunken, a condition known as enophthalmos, because the fracture increases the eye socket’s volume.
The Diagnosis Process
A medical evaluation for a suspected blow-out fracture begins with a physical examination. A doctor will assess vision, eye movement, and sensation around the cheek, upper lip, and nose to check for nerve damage. They also look for physical signs like swelling, bruising, and changes in the eye’s position.
While a physical exam provides clues, medical imaging is necessary to confirm the diagnosis. A computed tomography (CT) scan is the standard method for these injuries. CT scans create detailed, cross-sectional images of the orbit’s bones and soft tissues, allowing doctors to see the precise location and size of the fracture.
The detail from a CT scan helps determine the best course of treatment and plan any necessary surgery. The scan can show if eye muscles are trapped within the fracture, which is a primary factor in deciding if an operation is needed. The images provide surgeons with a clear map of the damaged area.
Treatment Options
Treatment for a blow-out fracture depends on the injury’s severity. For smaller fractures without significant double vision or a sunken eye, a non-surgical approach is sufficient. This management includes applying ice packs to reduce swelling and taking pain relievers. Patients are also advised to avoid blowing their nose, as this can force air from the sinuses into the eye socket.
Surgery is considered for more significant injuries, especially large fractures of the orbital floor. The decision to operate is based on criteria such as persistent double vision, evidence of muscle entrapment on a CT scan, or a noticeable sunken appearance of the eye. These factors may require surgical repair to prevent long-term issues.
The goal of surgery is to release trapped tissues from the fracture and rebuild the damaged orbital floor. To repair the break, surgeons may use a small implant made of titanium mesh or porous polyethylene to cover the hole and provide support. This procedure restores the eye socket’s normal volume, allowing the eye to function and appear properly.
Recovery and Complications
The recovery period varies based on the injury’s severity and treatment. Swelling and bruising around the eye diminish over a few weeks. Following treatment, patients are given instructions to aid healing, which may include restricting activities like contact sports for several weeks to prevent re-injury.
Most individuals recover well from a blow-out fracture with proper medical attention. However, severe or improperly treated injuries can lead to long-term complications. These can include permanent double vision, lasting numbness in the cheek and lip, or a permanent change in the eye’s appearance, though such outcomes are uncommon.