Orbital Floor Fracture, Non-Blowout

The eye sits in the part of the skull called the "orbit." The upper and outside walls of the orbit are thick and strong. The inside wall (near the nose) and the orbital floor are very thin and weak. The tissues around the eye will briefly press together if there is a direct blow to the front of the eye. This leads to high pressure against the orbital walls. The inside wall and the orbital floor may break since these are the weakest walls. If the orbital floor breaks, the tissues around the eye, including the muscle that makes the eye look down, may become trapped in the sinus below when the orbital floor "blows out." If a blowout does not happen, the orbital floor fracture is considered a non-blowout orbital fracture.

CAUSES

An orbital floor fracture can be caused by any accident in which an object hits the face or the face strikes against a hard object. The most common ways that people break their eye socket include:

  • Being hit by a blunt object, such as a baseball bat or a fist.

  • Striking the face on the car dashboard during a crash.

  • Falls.

  • Gunshot.

SYMPTOMS

If there has been no injury to the eye itself, symptoms may include:

  • Puffiness (swelling) and bruising around the eye area (black eye).

  • Numbness of the cheek and upper gum on the side with the floor fracture. This is caused by nerve injury to these areas.

  • Pain around the eye.

  • Headache.

  • Ear pain on the injured side.

DIAGNOSIS

The diagnosis of an orbital floor fracture is suspected during an eye exam by an ophthalmologist. It is confirmed by X‐rays or CT scan.

TREATMENT

Your caregiver may suggest waiting 1 or 2 weeks for the swelling to go away before examining the eye. When the swelling lessens, your caregiver will examine the eye to see if there is any sign of a trapped muscle or double vision when looking in different directions. If double vision is not found and muscle or tissue did not get trapped, no further treatment is necessary. After that, in almost all cases, the bones heal together on their own.

HOME CARE INSTRUCTIONS

  • Take all pain medicine as directed by your caregiver.

  • Use ice packs or other cold therapy to reduce swelling as directed by your caregiver.

  • Do not put a contact lens in the injured eye until your caregiver approves.

  • Avoid dusty environments.

  • Always wear protective glasses or goggles when recommended. Wearing protective eyewear is not dangerous to your injured eye and will not delay healing.

  • As long as your other eye is seeing normally, you may return to work and drive.

  • You may travel by plane or be in high altitudes. However, your swelling may take longer to go away, and you may have sinus pain.

  • Be aware that your depth perception and your ability to judge distance may be reduced or lost.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your vision changes.

  • Your redness or swelling persists around the injured eye or gets worse.

  • You start to have double vision.

  • You have a bloody or discolored discharge from your nose.

  • You have a fever that lasts longer than 2 to 3 days.

  • You have a fever that suddenly gets worse.

  • Your cheek or upper gum numbness does not go away.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.