What is an orbital fracture?
An orbital fracture is a broken bone in the eye socket. It involves the rim, floor (base) of the socket, or both the rim and the floor of the socket.
The eye socket surrounds and protects the eye and whilst being fairly thick at the rim, the floor and nasal sides of the pocket is paper thin in many places. These fractures are generally caused by direct impact of a blunt object to the face and depending on severity, may require surgery by a reconstructive surgeon to repair the bone.
Orbital fractures and their causes defined
There are three types of orbital fracture that may occur upon impact, these include:
Orbital rim fracture
Caused by direct impact to the face, most commonly caused during car crashes due to impact with a steering wheel or dashboard. Zygomatic rim fracture references to an injury involving the lower edge of the rim (cheekbone area), with a frontal rim fracture or sinus fracture involving the upper edge of the eye rim (part of the forehead). Due to the great deal of force required to cause these fractures, other injuries to the face are also likely including damage to the optic nerve eye muscles, or the nerves that provide sensation to forehead, cheek, sinuses.
Indirect orbital floor fracture
Also known as a ‘blowout fracture’, this occurs when the rim of the eye remains intact, but the paper thin floor of the socket cracks or ruptures. This damage can cause a small hole in the floor of the socket which may trap parts of the eye muscles or surrounding structures. The damage may also inhibit usual movement of the eye leading to double vision. Blowout fractures are usually caused by something marginally larger than the eye socket, for example; a baseball or a fist.
Direct orbital floor fracture
Sometimes an orbital rim fracture can extend to nearby sections in the floor of the eye socket, leading to both rim and socket floor fractures. These fractures occur in men more than women.
Symptoms
Symptoms vary depending on location and severity of the fracture however symptoms may include:
- A black eye: swelling, black and blue discolouration around the injury, bleeding on the white of the eye and on the inner lining of the eyelid.
- Double, decreased or blurred vision.
- Difficulty looking up, right, down, or to the left.
- Abnormal positioning of the eye in the socket (bulging or sunken).
- Numbness involving the forehead, eyelids, cheek, upper lip, or upper jaw on the same side as the injury (this indicates possible nerve damage).
- Puffiness under the skin near the eye, this is an accumulation of air and can be a sign that the fracture has reached through the wall of the sinus cavity.
- Swelling or deformity of the cheek or forehead.
- An abnormally flat looking cheek; possibly accompanied by severe pain whilst opening your mouth.
