The bony orbit's job is to protect the eyeball. In the event of a blow to the eye, the eyeball is often left undamaged. However, the power of the blow itself is transmitted throughout the orbit and the result is a blowout or break in the orbital floor. While the bones around the eye are quite strong, the bones that make up the orbital floor are fairly thin.
How Do I Know If It's a Blowout?After a severe blow to the eye, ER doctors will typically order a CT scan of the orbits and brain that will show where the damage has occurred. The fracture in the bones that make up the floor of the orbit can be seen clearly. Your doctor can also visualize the sinus cavities. Many times when an orbital blowout fracture occurs, blood and fluid seeps into the maxillary sinus cavity.
Symptoms of an Orbital BlowoutIf you experience a blow to the eye, the following symptoms may indicate an orbital floor blowout:
- History of eye trauma
- Pain upon looking up and down
- Sunken eye
- Double vision
- Severe eyelid and facial swelling
- Numbness of the upper cheek and gum
- Severe redness around the white part of the eye
Occasionally, the orbital floor breaks but does not completely blow out. If this occurs, one of the eye muscles can become trapped between the bones, causing vertical double vision or a restriction of eye movement when looking up or down. In addition, the nerve that innervates the cheek and upper lip can become damaged or irritated, causing numbness.
Patients are often visibly shaken because of the level of swelling and bruising that can occur. Also, broken blood vessels and bleeding can cause blood to accumulate directly underneath the conjunctiva, the clear covering on top of the white part of the eye. There can be so much blood that this tissue becomes elevated, causing the appearance of a protruding eye.
Orbital Floor Blowout TreatmentDepending on the damage, most people who suffer an orbital blowout will require surgery. ER physicians will first make sure you are stabilized and tend to any injuries that require immediate treatment. They will also prescribe general antibiotics to prevent infection. You will be instructed not to blow your nose for several weeks, as doing so can cause additional swelling, injury and possibly air to enter the tissue. Ice packs should be gently applied to the orbit for the first 48 hours. You will then be instructed to see your optometrist or ophthalmologist to make sure you do not have any other damage to your eye. Next, you will be referred to a maxillofacial surgeon who specializes in the repair of orbital blowout fractures.
Will an Orbital Blowout Cause Future Eye Problems?After about four weeks after the trauma, it is recommended that you see your eye doctor to rule out eye-related complications, such as:
- Orbital cellulitis
- Angle-recession glaucoma
- Retinal tear or detachment
Cullom, R. Douglas and Benjamin Chang. The Wills Eye Manual: Office and Emergency Room Treatment of Eye Disease, Second Edition. J.B. Lippincott Company, 1994.