Orbital Fractures

What is an orbital fracture?

An orbital fracture is when you break one or more of the bones surrounding your eyeball. These are your orbital bones, or the bones of your eye socket. This bony cavity contains your eyeball, eye muscles, blood vessels, nerves and other structures. Blunt force trauma — when something hits your eye very hard — is the most common cause of an orbital fracture.

Types of orbital fractures

You can fracture any of the bones surrounding your eyeball. A few types of orbital fractures include:

• Blowout fracture:A blowout fracture is the most common type of orbital fracture. This fracture is a break along the floor or thin inner wall of your eye socket. Getting hit in the eye with something like a fist or a baseball most often causes blowout fractures.
• Orbital rim fracture:An orbital rim fracture affects the bony outer edges of your eye socket. This area is made up of very thick bone, so it takes a lot of force to injure this area. Car accidents are the most common cause of orbital rim fractures. If you have an orbital rim fracture, you likely have other facial fractures.
• Orbital floor fracture:An orbital floor fracture is when the bones of the rim of your eye socket push back, causing your orbital floor bones to buckle downward. These fractures affect the nerves and muscles surrounding your eye, preventing it from moving properly. Car accidents and falls often cause orbital floor fractures.

What are the symptoms of orbital fractures?

Some people with orbital fractures have no symptoms. But they’re usually painful. It depends on what type of fracture you have and how severe your injury is. Symptoms may include:

• Blurred vision, double vision or decreased vision.
• Swelling under your eye.
• Black, blue or purple bruising around your eye (black eye).
• Blood in the white part of your eye.
• Swelling of your cheek or forehead.
• Numbness.
• Trouble moving your eye in any direction.
• Flattened cheek.
• Sunken eyeballs or bulging eyeballs.
• Nosebleed (epistaxis).

What causes orbital fractures?

Orbital fractures can occur in adults and children. The most frequent causes in adults include assaults (violence) and car accidents. The most common causes in children include car accidents and being hit in the face with a ball. Other causes of orbital fractures include bike accidents, motorcycle accidents, falls and other sports injuries.

What are the complications of orbital fractures?

Orbital fracture complications may include:

• Inability to move or feel part of your face (if you also injure a nerve or muscle).
• Trouble breathing, seeing, hearing or speaking, depending on where the fracture is located.
• Serious injuries can also lead to infections, seizures, bleeding in your brain and brain damage.

How is an orbital fracture diagnosed?

To diagnose an orbital fracture, an eye doctor (ophthalmologist) will examine your eye and the area surrounding it. They’ll check to see if your eye moves normally and if you have any vision issues. They may measure your eye to make sure it’s positioned correctly in your eye socket.

The ophthalmologist will also ask you about your symptoms and request imaging tests, like X-rays and CT (computed tomography) scans.

How is an orbital fracture treated?

Orbital fracture treatment depends on the type and severity of your eye injury. It doesn’t always require surgery. If you have a small fracture, an ophthalmologist may recommend using an ice pack to reduce eye pain and swelling. Your eye socket may heal on its own over time.

Your ophthalmologist may prescribe antibiotics or decongestants as well. They’ll instruct you to avoid blowing your nose while your injury heals. This can cause swelling if the air you blow out collects under the skin around your eye.

An orbital fracture is more severe when it prevents you from moving your eye correctly or if you also have double vision. If this is the case, your ophthalmologist may refer you to an oculoplastic surgeon. This type of surgeon is a specially trained ophthalmologist.

If you need surgery, the surgeon will let you know what type you need based on your symptoms and the severity of your injury.

After surgery, you may have bruising and swelling for several days. And your vision may be blurry for a few days following surgery. Your surgeon may recommend cold compresses, antibiotics or anti-inflammatory medication to help during the healing process.

Can orbital fractures be prevented?

You can’t always prevent orbital fractures, but there are certain things you can do to try to avoid them, including wearing:

• Safety gear, like a helmet or a face mask, when you play certain sports.
• A helmet when you ride a motorcycle or bicycle.
• A seat belt when you ride in or drive a car.

What can I expect if I have an orbital fracture?

The outlook for an orbital fracture depends on the type and severity of your injury. If you have a simple fracture, it may heal on its own over time. More severe fractures may require surgery. In the most severe cases, vision loss or double vision may occur. But most fractures heal without long-term effects.

How long does it take for an orbital fracture to heal?

Orbital fracture recovery time varies. Simple fractures may heal on their own over time. If your injury is severe and requires surgery, recovery may be prolonged. Some people develop nerve pain that can last for up to nine months. Other people may have persistent double vision, which could require another surgery. Enophthalmos, when your eyes sink in, may worsen with time.

When can I go back to work/school?

After surgery for an orbital fracture, most people can return to school or work within a week. Although, you may need to limit any strenuous activity, airplane travel and deep-sea diving for several weeks after surgery.

How do I take care of myself?

If you have an orbital fracture, an ophthalmologist may recommend ice packs or cold compresses to help with pain and swelling. You’ll also want to keep your head elevated above your heart level to help prevent further swelling. Pain relievers can help with the pain. To prevent nosebleeds, your ophthalmologist may recommend using a nasal spray to constrict your blood vessels for two to three days.

When should I see my healthcare provider?

If you’ve been treated for an optical fracture, return to your healthcare provider if you have:

• Nausea or vomiting.
• A headache that won’t go away.
• Fever.

When should I go to the ER?

You should go to your nearest emergency room or call 911 if you develop any of the following symptoms:

• Sudden, severe headache.
• Seizures.
• Difficulty walking, talking or seeing.
• Numbness or weakness in your body.
• Blood or fluid leaking from your nose or ear.
• Fainting.

What questions should I ask my healthcare provider?

Questions you may want to ask your healthcare provider include:

• Is an orbital floor fracture serious?
• What type of orbital fracture do I have?
• Do orbital fractures heal on their own?
• Do I need surgery?
• Will I need any type of follow-up treatment?

A note from Cleveland Clinic

It happens in a flash. A baseball comes flying at your eye. Or maybe you’ve sustained injuries in a car crash. Either way, you may have ended up with an orbital fracture. These types of fractures can cause pain, swelling and more severe symptoms like vision trouble. While an orbital fracture may go away on its own, it’s best to have it checked out by an ophthalmologist. They can determine if you need surgery or if ice and other at-home treatments are all you need to heal.