Introduction

The eye orbit or the eye socket is the cup like structure which houses the eyes and other structures of the eye anatomy. The rim of the eye orbit is made up of thick bones whereas the nasal and the lower portion of the rim are made up of thin bones. When a fracture takes place in the orbit it can take place in the periphery, floor or the nasal portion of the socket.

Types of orbital fracture

  • Orbital Rim Fracture- orbital rim fractures are the most common type of orbital fractures. This type of fracture is caused by a direct and a very impactful injury to the face. This fracture occurs very commonly in high speed automobile crashes and often occurs simultaneously with other facial bone injuries. Such impacts may also cause injuries to the brain. In cases where the damage is limited only to the eye area, other crucial parts of the eye may also get damaged. These include the eye muscles, the nerves which go through cheeks and forehead, the tear duct and the optic nerve. Orbital Rim Fractures can be broadly classified into categories; Zygomatic fractures and frontal sinus/frontal bone fracture.

A Zygomatic fracture occurs on the lower edge of the socket which is a part of the cheekbones and a frontal bone fractures occurs on the upper edge of the socket which is part of the frontal bone of the forehead.

  • Blowout Fracture or Indirect orbital floor fracture- in this type of fracture, while the socket of the eye remains intact, the floor of socket cracks or ruptures. Because of this a small hole may occur in the floor of the socket in which a part of the surrounding structure and eye muscles can get stuck. As a result double vision may be caused, as the injured eye may not be able to move properly in the socket. Such types of fractures occur by objects which are larger than the size of the eye.
  • Direct orbital floor fracture– a fracture in the rim of the socket which extends to other parts of the eye socket floor which causes fracture in the rim as well as the socket.

About 85% of the eye injuries are sustained at work, car crashes, sports etc. a study suggests men sustain more eye injuries than women. The number of eye injuries caused due to car accidents has gone down dramatically since the use of the airbags in the cars.

Symptoms of the orbital fracture:-

  • Swelling and blue or black colored discoloration around the eye.
  • Area of bleeding on the conjunctiva as well as the inner part of eyelids.
  • Blurry or decreased vision.
  • Visible abnormality in the positioning of the eye. It appears either to be bulging out or to be sunken in.
  • Due to possibility of associated nerve damage, a person can experience numbness in the cheeks, forehead, and upper lip on the same side as the injured eye.
  • If the fracture has broken in to some sinus cavity, maxillary sinus in particular, air may accumulate giving a puffy appearance t the skin under the eye.
  • Obvious visible dent of the broken bone.
  • Swelling of the cheeks and the forehead.
  • Severe pain in cheeks while trying to open the mouth.

Diagnosis

The first thing a doctor does while checking for a fracture is physical examination of the visible symptoms. The doctor may touch your cheek and forehead to check for any distortion. A patient may asked to look up and down to check if the muscles have been trapped under the socket due to the fracture. The area around cheeks and forehead are tested for numbness. An X-ray or a CT scan may also be done to confirm the fracture and to also gauge the magnitude of the crack. In case the person is unconscious, a doctor may order CT scan and x-ray to eliminate the possibility of any brain injury and to also see the extent of fracture.

Recovery

The recovery period completely depends upon the severity and the position of the fracture. If the injury is not very severe, the discoloration and swelling begin to fade away within 10 days, but the fracture obviously takes a longer amount of time to heal.

Prevention

Almost all eye injuries are preventable by being careful. It is important to wear protective eye wear while working. Also while playing sports like basketball and baseball, it is important to wear helmet and protective eye shield. While travelling in car, it is very important to wear the seat belt. In an unfortunate event of a car crash, the shoulder harness and the seat belt will prevent any high impact, straight to the face, facial bone injuries.

Treatment

The treatment depends on the severity of the injury. A small fracture which does not affect the eye movement can be treated with ice packs and antibiotics. If the fracture is more severe, a surgery may be needed to restore the vision and the abnormal positioned eye.