The orbital (eye) socket is a set of bones that surround and protect your eye. The bones around the eye form the walls and floor — sides and bottom — of the orbital socket and vary in thickness.
The rim is made from thick bones that are difficult to break. The base of the rim is formed from part of your cheekbone and the upper rim includes a part of the frontal bone in your forehead. Other parts of the eye socket — including the floor and areas around the nose — are paper thin and can break more easily.
Breaks to any of the bones in your eye socket are referred to as orbital socket fractures.
What Causes an Orbital Socket Fracture?
The main cause of an orbital socket fracture is a hard hit to your face. This can be from a ball, fist, steering wheel, or anything else that hits you in the face with a lot of force and leads to a fractured orbital bone.
The majority of all orbital fractures — and all eye trauma in general — is caused by accidents and rarely from intentional violence. Car accidents used to be a leading cause of orbital fractures, but the increased use of seatbelts and airbag requirements has greatly reduced this number.
Men are four times more likely to receive orbital fractures than women.
What Are the Types of Orbital Socket Fractures?
An orbital socket fracture is also called an eye socket fracture. Multiple parts of the eye socket can break at the same time, especially when the fracture is caused by a hard hit to your face. Different types of orbital socket fractures include:
- Rim fractures. These often happen from an impact that's hard enough to cause damage to many other parts of the eye, your face, and your brain. When the lower part of the rim is damaged it’s referred to as a zygomatic fracture. A frontal bone or sinus fracture is when the upper part of the rim breaks.
- Direct orbital floor fractures. These happen when a rim fracture extends to the bottom of the eye socket and also creates a break in the floor.
- Indirect orbital floor fractures. The rim isn’t broken in this type of fracture — just the floor is. These are also known as “blowout” fractures because the very thin base of the socket has formed a hole or crack. They're usually caused when the eye socket is hit by something larger than its opening, like a football. Other portions of your eye including your muscles and nerves might become partially trapped inside of this opening.
- Combined floor and wall fractures. These can lead to unique complications because you tend to lose a lot of support in your eye socket when both the sides and bottom of the socket are broken. Surgery will be required to repair this type of fracture. Your surgeon will have to be careful to create the correct volume in the reconstructed socket.
What Are the Symptoms of Orbital Socket Fractures?
Symptoms of an orbital socket fracture will depend on the type and severity of the break. Symptoms can include:
- A black eye
- Diplopia (double vision)
- Enophthalmos (when your eye is out of place)
- Numbness of surrounding areas, down to your lip
- Limited eye mobility and catching, particularly when you try to look up
What Are the Treatments for an Orbital Fracture?
A doctor will look at the function of your eyes. If they think that a break has occurred, they’ll need to be able to look closer at your socket. You’ll need to do a computed tomography (CT) scan, magnetic resonance imaging (MRI), or a similar technique.
If you have a mild fracture, you won't need surgery. Even problems with your vision can fix themselves over time without surgical treatment.
Indirect orbital fractures will only need surgery if another part of the eye has become trapped in the break or if more than 50% of the floor is broken. Most of the time this type of fracture is better when left alone.
Instead of surgery, your doctor will recommend that you:
- Keep ice packs on the eye
- Rest your face by avoiding strain from activities like nose blowing
- Take pain killers
Your doctor may prescribe antibiotics to prevent infection.
If the break is too severe or affects many parts of your eye socket, you’ll need surgery. Each surgery is specific to the break, but in general, the goal of eye socket surgery is to:
- Expose the site of the break
- Free any tissue that is trapped in the broken part of the socket
- Re-establish support for the socket, usually by using an implant made of materials like nylon, silicone, and titanium mesh
There are a number of risks involved in eye socket surgery, including:
- Risk of death — often due to a combination of injuries around the eye
- Loss of some or all of your eyesight
- Developing diplopia (double vision)
- Significant facial asymmetries or displacement of your eyeball
What to Expect After Orbital Socket Fracture Surgery
Your doctor will take images of your eye socket immediately after — or within a few days of — your surgery. You’ll also need a follow-up imaging session three to six months after surgery to make sure that your socket is healing correctly.
Your doctor will want to make sure that you don’t become infected with meningitis. This can happen even years after the surgery. Your doctor may or may not recommend antibiotics after orbital socket surgery.
You can’t blow your nose for 10 days, scuba dive for six weeks, or fly in a military plane for six weeks after your surgery. Commercial airplanes are fine.
In very rare cases your implant will need to be removed. This is only if it becomes infected or causes lasting swelling in your eye tissues. Sometimes patients will also request for the implant to be removed if it becomes visible around the edges of the eye.
It’s important that you see your doctor if you have been hit hard in the eye and are showing any of the symptoms of a fracture.