Dangers of Orbital Blowout Fracture

Broken Bones Around the Eye Can Damage the Optic Nerve

The eye rests in the eye socket. This socket is made up of bones that surround the sides, floor and back of the eye. These bones are referred to as the bony orbit. At the back of the bony orbit there is a small opening called the optic foramen, or optic canal. A nerve called the optic nerve connects to the back of the eye and travels through this opening. It then travels to the part of the brain that interprets vision, which is called the occipital lobe.

While the bony orbit is very strong, the bones are vulnerable to fracture if the head impacts another object with great force, such as the pavement, a dashboard, or a projectile such as a bat or fist. When the bones supporting and protecting the eye are fractured during head trauma, the injury may be called an orbital blowout fracture, or orbital floor fracture.

Dangers of Orbital Fracture

If the bones surrounding the eye are fractured, the eye loses some of its support. One noticeable sign of broken eye socket bones may be an eye that protrudes forward or sinks back into the skull. This sign would be in addition to bruising, redness, and swelling. Other signs and symptoms include:

  • Bleeding into the eye
  • Nose bleeds
  • Cheek, nose or tooth numbness
  • Double vision
  • Inability to move the eye
  • Pain with eye movement

Fractured bones have jagged edges, and these edges can push into the actual eyeball, or cut blood vessels and nerves in the surrounding area.

One of the greatest concerns with an orbital fracture is damage to the optic nerve. The small opening at the back of the eye, the optic foramen, needs to remain intact so nothing interferes with the connection between the eye and occipital lobe of the brain.

The optic nerve may be damaged if broken bones cut into or through the nerve.

If there is swelling and pressure in the area, blood flow to the eye and the optic nerve may be cut off. This is dangerous  because the nerve needs a constant supply of oxygen and nutrients in order to stay alive.

The optic nerve is essential for vision, and it is not possible to repair this nerve once it has been damaged. Optic nerve damage can lead to permanent blindness.

Treating Eye Socket Fractures

Time is of the essence in these types of injuries. The longer the eye and nerves are under pressure or exposed to fragmented bone, the higher the risk of blindness. An x-ray or CT scan is usually the first step in correctly diagnosing the fracture.

Highly trained surgeons are needed when there is an orbital fracture. A neuro-ophthalmologist specializes in all of the nerves that control the eye and make vision possible; an ophthalmic plastic surgeon specializes in reconstructing the bones, blood vessels and soft tissues that hold the eye in place and allow it to move. Surgical repair of this type of an injury will usually include both specialists.

It may also be necessary to have several eye surgeries.

During surgery, eye bones are stabilized, tissues that are trapped between broken bones released, and swelling or bleeding around essential nerves is addressed to reduce pressure.

Long Term Effects of Orbital Blowout

Many orbital fractures heal well on their own. In some cases, long-term double vision may be present and need additional treatment. Strabismus, sometimes referred to as lazy eye, may develop. There are a number of​ therapies and treatments that can help the eye regain movement and strength.


Han, H. H., Park, S. W., Moon, S., Seo, B. F., Rhie, J. W., Ahn, S. T., & Oh, D. Y. (2015). Comparative Orbital Volumes between a Single Incisional Approach and a Double Incisional Approach in Patients with Combined Blowout Fracture. Biomed Research International, 20151-6. doi:10.1155/2015/982856

Saiga, A., Mitsukawa, N., & Yamaji, Y. (2015). Reconstruction using ‘triangular approximation’ of bone grafts for orbital blowout fractures. Journal Of Cranio-Maxillo-Facial Surgery, 431369-1373. doi:10.1016/j.jcms.2015.07.002

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