Orbital Fracture: Signs, Diagnosis and Treatment

Any forceful blow to the face or eye area can fracture the delicate bones of the orbit. Sports injuries are among the most frequent causes, particularly from balls, elbows, or collisions in sports such as baseball, basketball, and soccer. Motor vehicle accidents, falls, and physical altercations also account for a significant number of orbital fractures. Workplace injuries involving tools or heavy objects can produce this type of trauma as well.

Men are more likely than women to sustain orbital fractures, often due to higher participation in contact sports and occupational hazards. Children and adolescents can also experience these injuries, and their fractures may require more urgent attention because their more flexible bones can trap surrounding tissue tightly. Older adults with thinner, more fragile bone may fracture the orbit from lower-energy impacts such as a fall.

A blowout fracture is a break in the thin floor or medial wall of the eye socket that occurs when a direct blow increases pressure inside the orbit. The force causes the thinnest bone to buckle outward, often pushing orbital fat or muscle into the sinus cavity below. The orbital rim itself remains intact, which distinguishes a blowout fracture from rim fractures caused by direct impact to the bone edge. Blowout fractures are the most common type of orbital fracture seen in clinical practice.

Not all orbital fractures need surgical repair. Surgery is typically recommended when there is persistent double vision caused by tissue entrapment, significant enophthalmos, or a large fracture that is unlikely to stabilize on its own. Our oculoplastic surgeons usually observe the injury for up to two weeks to allow swelling to subside, unless there is an urgent indication such as a trapped muscle in a child, retrobulbar hemorrhage, or early signs of vision loss. Small, nondisplaced fractures with no functional problems often heal well with observation alone.

The goal of surgery is to free any trapped tissue and restore the normal contour of the orbital walls. Our oculoplastic surgeons access the fracture through a small incision, typically hidden inside the lower eyelid (transconjunctival approach) or just below the eyelash line (subciliary approach). Herniated tissue is repositioned into the orbit, and the bony defect is covered with an implant material to support the floor. Surgery is performed under general anesthesia, and most patients go home the same day or after an overnight stay for monitoring.

Many uncomplicated orbital fractures heal within four to eight weeks. After surgical repair, most patients can return to work or school within about one week, though strenuous activity, heavy lifting, nose blowing, and air travel are typically restricted for at least three weeks. Orbital floor strength is generally regained within three to four weeks following repair. Your surgeon will monitor healing through follow-up visits and advise you when it is safe to resume all activities.

Yes, double vision is one of the most frequently reported symptoms. It occurs when orbital fat or an extraocular muscle becomes trapped in the fracture, limiting the eye's ability to move freely. In many cases, diplopia improves as swelling decreases over the first one to two weeks. When double vision persists beyond that period due to mechanical entrapment, surgical release of the trapped tissue is usually the most effective path to resolution.

Most patients recover well, particularly when they receive timely evaluation and appropriate treatment. Possible long-term effects include persistent enophthalmos if the orbital volume is not fully restored, chronic numbness from infraorbital nerve damage, and residual double vision in certain gaze positions. In rare cases, complications such as retinal vascular injury or optic nerve damage can affect vision permanently. Wearing protective eyewear during sports and high-risk activities can significantly reduce the risk of orbital trauma and related injuries such as corneal abrasions.