The eye socket, or orbit, is the bony cup surrounding your eye. Seven different bones make up the socket.
The eye socket contains your eyeball and all the muscles that move it. Also inside the socket are your tear glands, cranial nerves, blood vessels, ligaments, and other nerves.
The eye socket is divided into four parts. Each is formed by separate bones. You can have a fracture in one or all of these parts of the eye socket:
- The inferior wall, or orbital floor, is formed by the upper jawbone (maxilla), part of the cheek bone (zygomatic), and a small part of the hard palate (palatine bone). Fractures to the inferior floor most commonly come from a blow to the side of the face. This could be from a fist, a blunt object, or a car accident.
- The zygomatic bone also forms the temporal, or outer, side wall of the eye socket. Many important nerves run through this area. They can be damaged by a blow to the cheek or side of the face.
- The medial wall is formed primarily by the ethmoid bone that separates your nasal cavity from your brain. Blunt trauma to the nose or eye region is a common cause of fractures to the medial wall.
- The superior wall, or roof, of the eye socket is formed by a part of the frontal bone, or forehead. Fractures to the superior wall are less common, but they can happen alone or in combination with damage to the other two areas.
One study found that 28 percent of people with eye socket fractures also have eye injuries that can affect vision.
Types of fractures
Any or all of the seven orbital bones may be involved in an eye socket fracture.
Fractures of the eye socket can be classified into the following categories:
Orbital rim fractures
These occur when the eye socket is struck violently with a hard object, such as a steering wheel in a car accident. A piece of bone may break off and be pushed in the direction of the blow.
The damage is usually in more than one area of the eye socket. A common type of orbital rim fracture involves all three major parts of the eye socket. It’s called a tripod fracture, or a zygomaticomaxillary complex (ZMC) fracture.
Blowout fractures (or comminuted orbital wall fractures)
This type of fracture commonly happens when you’re struck by something larger than the eye socket, such as a fist or blunt object. It can result in multiple pieces, or comminuted, bone.
The blowout happens when a punch or other blow to the eye causes a pressure buildup in the fluid of the eye. This pressure is transmitted to the eye socket, causing it to fracture outward. Or, the wall may buckle inward from force on the rim.
These are most common in children, since they have more flexible bones than adults. Instead of shattering, the bone of the eye socket flexes outward, and then immediately returns back to position. Thus, the name “trapdoor.”
Although the bones aren’t broken, the trapdoor fracture is still a serious injury. It can lead to permanent nerve damage.
Symptoms of an eye socket fracture
Symptoms of eye socket fracture include:
- double vision or reduced vision
- swelling of the eyelid
- pain, bruising, tearing, or bleeding around the eye
- nausea and vomiting (most common in trapdoor fractures)
- sunken or bulging eye, or droopy eyelid
- inability to move your eye in some directions
Diagnosing the fracture
Your doctor will examine the damaged eye area and your vision. They’ll also check your eye pressure. Continued elevated eye pressure can lead to damage of the optic nerve and blindness.
An eye specialist, called an ophthalmologist, will likely be involved if there’s any damage to vision or motion of the eye. Fracture to the orbital roof may require consultation with a neurologist or neurosurgeon.
Treating the fracture
Eye socket fractures don’t always require surgery. Your doctor will determine if your fracture can heal on its own.
You may be advised to avoid blowing your nose for several weeks after the injury. This is to prevent infection spreading from the sinuses to eye socket tissue though a small space in a fractured bone.
Your doctor may prescribe a nasal decongestant spray to help prevent the need for nose blowing or sneezing. Many doctors also prescribe antibiotics to prevent an infection from occurring.
There’s some debate over the criteria for using surgery in blowout fractures. Here are some reasons surgery may be necessary:
- If you continue to experience double vision for days after the injury, surgery may be needed. Double vision can be a sign of damage to one of the eye muscles that help move your eye. If the double vision goes away quickly, it was probably caused by swelling and doesn’t need treatment.
- If the injury caused the eyeball to be pushed back in the socket (enophthalmos), this may be an indication for surgery.
- If one half or more of the inferior wall was damaged, surgery will likely be needed to prevent facial deformity.
If surgery is needed, your surgeon may wait for up to two weeks after the injury to allow the swelling to go down. This allows for a more accurate examination of the eye socket.
The usual method of surgery is a small incision at the outside corner of your eye and one on the inside of your eyelid. An alternative method, endoscopy, is being used by a growing number of surgeons. In this procedure, surgical cameras and instruments are inserted through the mouth or nose.
This surgery requires general anesthesia, which means you’ll be asleep for the procedure and won’t feel any pain.
If you have surgery, you may be given the option of an overnight stay in the hospital or surgical facility. Once home, you’ll need assistance for at least two to four days.
Your doctor will likely prescribe oral antibiotics, corticosteroids like prednisone, and pain killers, usually for a week. The surgeon will likely advise you to use ice packs on the area for a week. You’ll need to rest, avoid blowing your nose, and avoid strenuous activity for at least two to three weeks after surgery.
You’ll be asked to return to the doctor within a few days after surgery, and probably again within the next two weeks.
What's the outlook?
Although eye socket fractures can be dangerous, most people recover well.
If you went into the surgery with double vision, it may last as long as two to four months after surgery. If it doesn’t go away after four to six months, you may need eye muscle surgery or special corrective glasses.
Can this be prevented?
Wearing protective eyewear when working or while engaging in sports can help prevent many eye socket fractures.
Goggles, transparent face shields, and face masks may be appropriate, depending on the type of activity.