BLOWOUT FRACTURE OF THE ORBIT
Excerpted from Triad's Eye Care Notes © 1989-2005 by Triad Publishing Co.

Each of your eyeballs lies within an orbit (eye socket), an open cavity in the skull that is bordered by strong bone, some of which is very thin. If your eye or eye region is hit, as by a fist or ball, it can cause a sudden increase in pressure within the orbit. The result can be a blowout fracture of the orbit -- a break in one of the thinner orbit bones and the possibility of the nerves and eye muscles in the orbit being pushed through the break. A blowout fracture of the orbit can be a very serious injury.

Symptoms

If any blood vessels have been broken, blood will rush into the tissues and cause a classic swollen "black eye." After the swelling goes down, the eye may appear to be sunken back because the tissues have been pushed out of the orbit through the broken bone. You may also have double vision (diplopia) whenever you look up or down. The lower part of the cheek and some of the upper back teeth on the same side as the fractured orbit may become numb. Very rarely, severe pain and nausea occur immediately after the injury.

Examination

The eye and lids will be thoroughly examined to determine the extent of the injury. Your vision will be evaluated, pupil size and reaction to light evaluated, and eye movements checked. Then with the pupils dilated (enlarged) with eyedrops, the inside of the eye will be examined with an ophthalmoscope. If a blowout fracture is suspected, you may have various types of x-ray examinations of the orbital bones and other facial bones. If swelling is so severe as to make the eye examination painful, or even hazardous, it may be postponed. After a week or two, the swelling will go down and then there can be a full evaluation and a decision made as to treatment.

Treatment

Your treatment will depend on the type and extent of the damage. If there is no serious injury except for the orbital bone, it may be allowed to heal without any treatment. But if it appears that double vision or a sunken eyeball might be permanent, the fractured bone may need to be repaired surgically, possibly sealing the hole with a thin plastic implant.

Surgical repair of a "blowout" is rarely undertaken immediately; it can be safely postponed for up to two weeks, if necessary, to let the swelling subside. Surgery to place an orbital implant leaves little or no scarring and the recovery period is usually brief. Hopefully, the surgery will provide a permanent cure, but sometimes it provides only partial relief from double vision or a sunken eye.

Excerpted from Triad's Eye Care Notes © 1989-2005 by Triad Publishing Co.

Patients: for more information about your eyes, see: Taking Care of Your Eyes: A Collection of the Patient Education Handouts Used by America's Leading Eye Doctors