Orbital fracture repair restores the bony architecture of the eye socket, often using a small implant to support soft tissues. The primary goals are to correct or prevent double vision and the sunken appearance of the eye (enophthalmos) resulting from the injury. The healing timeline is divided into distinct phases, each with specific expectations and care requirements. This guide outlines what to anticipate during the weeks and months following the surgery.
Immediate Post-Operative Care (The First 48 Hours)
The first two days focus on managing the acute physical response to surgery, primarily swelling and bruising. Swelling around the eye is expected and often peaks on the second or third day. To minimize this, patients should apply cold compresses over the affected area for 15 to 20 minutes at a time during waking hours for the initial 48 hours.
Maintaining an elevated head position, even while sleeping, promotes fluid drainage and reduces discomfort. Pain is manageable with prescription medication, which should be taken as directed for consistent relief. Temporary changes in vision, such as blurriness or mild double vision, may occur immediately due to residual swelling and tissue manipulation. These initial visual symptoms typically subside quickly as the swelling recedes.
Managing Recovery and Activity Restrictions
The recovery period, extending through the first six weeks, focuses on protecting the surgical site and allowing tissues to stabilize. A central restriction is avoiding activities that increase pressure within the sinuses, which are near the orbital floor. Patients must not blow their nose for at least two to three weeks, and sneezing should be done with the mouth open to prevent air from entering the orbit.
Straining, heavy lifting, and bending over must also be avoided for four to six weeks, as these actions increase pressure in the face and head. Strenuous physical activity, including intense exercise, should be limited for a minimum of four weeks post-surgery. Sedentary work is often allowed within one week, but manual labor requires a more conservative return timeline of two or more weeks.
Care for external incisions involves gentle cleaning and applying prescribed antibiotic ointment to prevent infection. If the repair involved an incision inside the mouth, a soft diet may be recommended for the first week. Follow-up appointments, often starting within the first week, monitor healing progress, check eye movement, and allow for the removal of non-dissolvable sutures.
Identifying and Addressing Post-Surgical Complications
While some pain and swelling are normal, certain signs require immediate medical attention as they indicate a deviation from expected recovery. A sudden, severe increase in eye pain, rapid swelling, bulging of the eye, or a significant decrease in vision may signal a retrobulbar hemorrhage. This condition involves bleeding behind the eye creating pressure on the optic nerve.
Signs of infection include a persistent fever, increasing redness and warmth around the eye, pus-like discharge, or worsening pain not relieved by medication. Persistent or newly developed double vision after the first few days is also a concern, especially if it limits eye movement. This may indicate re-entrapment of an eye muscle or a problem with the implanted material.
A noticeable change in the eye’s position, such as sinking back into the socket or sitting lower than the unaffected eye, suggests a potential reconstruction issue. Any of these symptoms warrant contacting the surgical team immediately, as early intervention is necessary to prevent long-term functional or cosmetic problems.
Expected Long-Term Results and Follow-Up
The full functional and cosmetic results become apparent over several months as swelling resolves and tissues heal. Persistent numbness in the cheek, upper lip, or upper teeth, caused by infraorbital nerve manipulation, frequently improves over four to six months. Double vision, if present after initial swelling subsides, typically continues to improve within the first two to four months as eye muscles recover.
If double vision does not fully resolve, further treatment, such as prism glasses or eye muscle surgery, may be required after six months of observation. External scars generally fade significantly over the course of a year. Final clearance for high-risk activities, such as contact sports, is usually given around three to six months post-surgery, confirming adequate bone stability.