A broken orbital bone is a fracture in one or more bones forming the eye socket. This bony structure protects the eye and its surrounding components.
Understanding the Orbital Bone and Fractures
The orbital bone, or orbit, is a bony cavity composed of seven different bones: the frontal, zygomatic, maxillary, palatine, ethmoid, lacrimal, and sphenoid. This structure protects the eyeball, eye muscles, nerves, blood vessels, and fatty tissue. The walls of the orbit act as a physical barrier against blunt force trauma and serve as attachment points for muscles and ligaments that enable eye movement.
Fractures to these bones typically occur at their weaker points, such as the inferior orbital wall, also known as the orbital floor, and the medial wall. The most common type is a “blow-out” fracture, which involves a break in the floor or the thin inner wall of the eye socket while the outer orbital rim remains intact. These often result from direct impact to the eye itself, such as from a fist or a ball.
Another type is an orbital rim fracture, affecting the thicker outer edges of the eye socket. These require substantial force and are frequently associated with other facial fractures. Orbital floor fractures can also occur as an extension of a rim fracture or as isolated injuries, potentially affecting the nerves and muscles that control eye movement. In some cases, particularly in children, a “trapdoor” fracture can occur where a bone fragment temporarily displaces and then snaps back, trapping orbital tissues.
Recognizing the Signs
Orbital bone fractures commonly result from blunt force trauma to the face. Common causes include assaults, motor vehicle accidents, falls, and various sports injuries.
Immediate signs often include pain around the eye, swelling, and bruising, commonly known as a black eye. Vision changes are also common, such as double vision (diplopia), blurred vision, or a decrease in overall vision. This can be due to eye muscle entrapment, swelling within the orbit, or nerve damage.
Numbness or tingling sensations over the cheek, eyelids, upper lip, and even teeth can occur if the infraorbital nerve is affected. Difficulty moving the affected eye is another frequent symptom, indicating potential muscle involvement. Physical appearance might change, with the eye appearing sunken (enophthalmos) or, less commonly, bulging (proptosis), or the cheek appearing flattened. Some individuals may also experience nosebleeds or a crunching sensation around the eye due to air trapped under the skin, known as orbital emphysema.
Medical Assessment and Care
Medical professionals diagnose orbital fractures through a combination of physical examination and imaging studies. A thorough physical exam involves assessing visual acuity, eye movements, pupillary reactions, and checking for changes in sensation around the eye. The orbital rim may be carefully palpated to detect irregularities.
Computed tomography (CT) scans are the standard imaging method for confirming an orbital fracture. These scans provide detailed views of the bony structures and surrounding soft tissues. Magnetic resonance imaging (MRI) may also be used to evaluate soft tissue damage.
Treatment approaches vary based on the fracture’s severity. For small fractures with minimal symptoms or displacement, conservative management is often recommended. This involves applying ice packs to reduce swelling, pain relief, and close observation. Patients are advised to avoid blowing their nose to prevent complications like orbital emphysema. Antibiotics may be prescribed to prevent infection, especially if the fracture involves the sinuses.
Surgical intervention becomes necessary for more severe fractures. Indications for surgery include persistent double vision due to muscle entrapment, significant displacement of the eye, or large fractures affecting more than half of the orbital floor. While surgery is often delayed for about two weeks to allow initial swelling to subside, urgent surgery may be required for muscle entrapment, particularly in children, to prevent potential long-term issues. The goal of surgery is to restore the normal anatomy of the orbit, free any trapped tissues, and provide support for the eye, often utilizing implants made from materials like porous polyethylene or titanium mesh.
What to Expect Post-Injury
The recovery time following an orbital bone fracture varies depending on the injury’s extent and the treatment received. Simple fractures that do not require surgery may heal on their own over time, while more severe injuries, especially those requiring surgical repair, can have a prolonged recovery period. Healing can take anywhere from four to eight weeks, with complex cases potentially requiring two to three months for recovery.
Immediately after surgery, some swelling and bruising around the eye are common, and vision might be temporarily blurry for a few days. Pain medication is prescribed to manage discomfort during the initial recovery phase. It is important to avoid blowing your nose for at least 10 to 14 days after the injury, particularly after surgery, to prevent air from entering the orbital tissues. Strenuous activities and heavy lifting should also be avoided for at least three weeks to prevent complications and allow for proper healing.
Some individuals may experience long-term effects. These can include persistent double vision, a sunken appearance of the eye, or ongoing numbness in areas supplied by affected nerves. Cosmetic changes, such as facial asymmetry, can also occur. Regular follow-up appointments with a medical professional are important to monitor the healing process, assess vision, and address any potential long-term complications.