Orbital Fracture (Broken Eye Socket)

What to do right away

1. Apply a cold pack gently over the closed eye for 15 to 20 minutes at a time. Do not press on the eyeball.
2. Keep your head raised, including when sleeping.
3. Do not blow your nose. Air can be forced into the tissues around the eye. Sneeze with your mouth open.
4. Do not apply pressure if the eye itself might be injured. Protect it with a rigid shield, such as the bottom of a paper cup, taped over the bone.
5. Get the eye checked at an ER or by an eye specialist.

Anatomy of the eye socket

The orbit is made of seven bones. Its rim is thick and strong, but its floor (above the maxillary sinus) and inner wall (next to the ethmoid sinuses) are paper-thin. This design acts like a crumple zone: when the eyeball is struck, the thin walls break and absorb force, which may protect the eye itself.

Types of orbital fracture

Symptoms

• swelling and bruising around the eye (black eye)
• pain, especially when moving the eye
• double vision, particularly looking up or down
• numbness of the cheek, side of the nose, upper lip and upper teeth, from injury to the infraorbital nerve
• a sunken eye (enophthalmos) or one that sits lower, often noticed after swelling goes down
• nosebleed on the same side
• crackling under the skin (air from the sinuses)
• redness or bleeding on the white of the eye

The "white-eyed" blowout in children

Children can have a trapdoor fracture with little bruising but severe restriction of eye movement, pain, nausea, vomiting and a slow heart rate when trying to look up or down. This needs surgery within hours to save the trapped muscle.

Diagnosis

• complete eye exam by an ophthalmologist: vision, pupils, eye pressure, eye movements and examination of the retina. Eye injuries such as hyphema, retinal tears or globe rupture occur in a significant share of orbital fractures
• CT scan of the orbits, the test of choice for orbital fractures
• checks for other facial fractures and head injury

Treatment

Non-surgical

Many small fractures without muscle entrapment or significant displacement heal on their own:

• cold packs and head elevation
• no nose-blowing for several weeks
• decongestant nasal sprays in some cases
• antibiotics are sometimes prescribed, because the fracture opens into a sinus
• short courses of oral steroids to reduce swelling, in selected cases
• follow-up exams to check eye position and double vision as swelling settles over 1 to 2 weeks

Surgery

Surgery repairs the bone, often with a thin plate or implant, and releases any trapped tissue. It is recommended for:

• muscle entrapment, especially in children, ideally within 24 to 48 hours
• persistent double vision that is not improving after 1 to 2 weeks
• large fractures (for example involving more than half of the floor) likely to cause a sunken eye
• visible enophthalmos (a sunken eye)
• displaced rim fractures or complex facial fractures

Surgery is often timed after swelling settles, within about 2 weeks, unless there is entrapment.

Recovery

Swelling and bruising usually fade over 2 weeks. Numbness of the cheek often improves over weeks to months, though it can persist. Double vision from swelling commonly resolves. After surgery, most people return to normal activities in a few weeks, avoiding contact sports for about 6 to 8 weeks.

Complications

• persistent double vision
• sunken eye (enophthalmos)
• permanent cheek numbness
• infection, including orbital cellulitis
• vision loss from associated eye injury or bleeding behind the eye
• later eye problems such as glaucoma or retinal detachment after significant eye trauma

Prevention

• wear protective eyewear for racquet sports, baseball, softball and work involving flying debris
• use seat belts and airbags
• wear face shields where appropriate in sports

See also facial fractures and nasal fracture.

Frequently asked questions

What are the symptoms of a broken eye socket?

Symptoms include swelling and bruising around the eye, pain when moving the eye, double vision, numbness of the cheek or upper lip, a nosebleed, and sometimes a sunken or lower eye. Any of these after a blow to the eye area need medical evaluation.

What is a blowout fracture?

A blowout fracture is a break in the thin floor or inner wall of the eye socket, caused when a blow increases pressure inside the orbit. The strong outer rim stays intact. Eye muscles or fat can become trapped in the break, causing double vision.

Does an orbital fracture need surgery?

Many do not. Small fractures without trapped muscle or a sunken eye often heal on their own. Surgery is needed for trapped muscles, especially in children, persistent double vision, large fractures or a visibly sunken eye.

Why can't I blow my nose after an orbital fracture?

The fracture often connects the eye socket with a sinus. Blowing your nose can force air into the tissues around the eye, causing sudden swelling and possibly infection. Doctors usually advise avoiding nose-blowing for several weeks.

How long does an orbital fracture take to heal?

Swelling and bruising usually improve within 2 weeks, and bones heal over about 6 weeks. Numbness can take months to recover. If surgery is needed, most people resume normal activities within a few weeks and contact sports after 6 to 8 weeks.