Orbital Facial Fractures

The orbit (eye socket) is the bony cavity that surrounds and protects the eye. The rim of the orbit is comprised of thick bones, while the floor and nasal walls of the orbit are very thin. A fracture (broken bone) can occur in the socket, and can involve the orbital rim, floor, and/or nasal wall. Rarely fractures of the orbital roof or outside wall of the orbit can occur after severe trauma.

When injuries or accidents happen, patients are often rushed to multi-specialty hospitals. However, once life-threatening injuries are stabilized, or absent, immediate attention to the face, and particularly the eye region is important. Trauma can affect any structure of the eyelid, eyeball and the surrounding bones (fractures) depending upon the mechanism and force of injury. Eyelid is a delicate and important structure, and if injured, needs meticulous placement of stitches to preserve its normal shape and function. Injury to the tear ducts (canaliculus) within the eyelids require special placement of silicone tubes within them to keep them open while the injured eyelid heals. Fractures of the bone surrounding the eye (orbital walls) may cause the eye to sink back into its socket, lead to a facial deformity, poor eye movement, or loss of vision. More extensive injuries to facial bones may require a maxilla-facial surgeon to be one of the trauma team members.

A thorough examination is required to find out if the eyeball and surrounding structures are injured. This has to be followed by immediate repair of injured tissues by multispecialty approach by more than one eye specialist. The outcome of trauma repair entirely depends upon extent and severity of injury. Treatment may be needed in stages, and healing may continue for months. Health insurance will cover the costs of trauma repair.

Types of orbital facial fractures include:

• Orbital floor and/or nasal wall fracture (“blowout fracture”): occurs when the bony rim of the orbit remains intact, but the floor of the socket fractures. This can occur after a motor vehicle accident, trauma with a sports ball such as a tennis ball or baseball, or a punch in the eye with a fist
• Orbital rim fracture: often occur with extensive injuries to other facial bones and, in some cases, brain injury
• Tripod fracture: fracture of the cheek bone under the eye, combined with blowout fracture

While they vary depending on the location and severity of the fracture, symptoms of an orbital facial fracture include:

• Abnormal position of the eye, such as bulging or sinking down into a lower position
• Abnormally flat-looking cheek, and possibly severe pain in that cheek when opening the mouth or chewing
• Bruising and swelling around the eye
• Difficulty looking up, down, right, or left
• Double vision, decreased vision, or blurry vision
• Numbness of the cheek, upper lip, or upper teeth on the same side as the injured eye, which could be related to nerve trauma caused by the fracture
• Swelling and deformity of the cheek or forehead

Tests

Comprehensive exam – Your doctor will conduct a thorough physical examination of your eyes and face – as well as gather information on how the injury occurred – to determine if you have an orbital facial fracture. Past medical and surgical histories will also be obtained.

Imaging – If your doctor suspects you have an orbital fracture, he or she may recommend you undergo a computerized tomography (CT) scan of the area around your eye to confirm the diagnosis.

Treatments

Cold compress – Your doctor may recommend you use a cold compress or ice pack to reduce swelling and control pain.

Decongestant – Your doctor may prescribe a nasal decongestant medicine to help control swelling in the areas around your eye.

Antibiotic – Your doctor may prescribe an antibiotic medicine to prevent infection in the area around your orbital fracture.

Rest – Your doctor will instruct you to avoid any strenuous exercise, and will instruct you to not forcefully blow your nose after the fracture has been diagnosed. This is to prevent air from the sinuses around the eye from going under the skin and causing swelling and more discomfort.

Surgery – If your fracture is more severe, you may need to undergo reconstructive surgery to free up any tissues or muscles entrapped in the bony fractures, eliminate double vision, restore the normal position of your eye in the socket if your injured eye has sunken in, and repair deformities of the eye rim that affect your appearance and may cause discomfort.  A thin implant is usually placed to reconstruct the fractured floor and/or nasal walls of the orbit.  Most implants are made of a synthetic porous material that results in your own tissues growing into the implant, making it more resistant to infection or migration.

Post-Op Care – If you need to undergo surgery, your doctor will treat you with ice packs for the first 48 hours while awake.  You may have a suture pulling the lower eyelid upward for a week after the surgery. An antibiotic ointment is prescribed to use on the eye three times per day for a week, and that will blur your vision.  Some patients may need an oral (by mouth) antibiotic prescription for a week after surgery.

Additionally, there may be some discomfort the first few days after surgery, and pain medication may be prescribed as well.  After surgery, it is not uncommon to have some temporary double vision as well as increased numbness of the side of the face due to manipulation of the tissues to repair the fracture.  This usually resolves fairly quickly.  If you have numbness of the face before surgery, that may take several months to totally resolve.