Indirect orbital floor fracture ("blowout fracture"). This occurs when the bony rim of the eye remains intact, but the paper thin floor of the eye socket cracks or ruptures. This can cause a small hole in the floor of the eye socket that can trap parts of the eye muscles and surrounding structures. The injured eye may not move normally in its socket, which can cause double vision. Most blowout fractures are caused by an impact to the front of the eye from something bigger than the eye opening, such as a baseball, a fist or an automobile dashboard.

Approximately 2.5 million traumatic eye injuries, including eye socket fractures, occur each year in the United States. About 85% of these injuries happen by accident, during contact sports, at work, in car crashes or while doing home repair projects. About 15% are caused by violent assaults.Men suffer from traumatic eye injuries about four times more often than women do. The average age of the injured person is about 30. The source of the injury is usually a blunt object -- baseball, hammer, rock, piece of lumber -- and the most frequent place of injury is the home. At one time, eye injuries were common in motor vehicle accidents, usually when a victim's face struck the dashboard. Such eye injuries have decreased dramatically because more cars have airbags, and most states have laws mandating the use of seat belts.

Symptoms vary, depending on the location and severity of the fracture, but can include:

• A black eye, with swelling and black and blue discoloration around the injured eye; possible redness and areas of bleeding on the white of the eye and on the inner lining of the eyelids
  
  
• Double vision, decreased vision or blurry vision
  
  
• Difficulty looking up, down, right or left
  
  
• Abnormal position of the eye (either bulging out of its socket or sunken in)
  
  
• Numbness in the forehead, eyelids, cheek, upper lip or upper teeth on the same side as the injured eye, possibly related to nerve damage caused by the fracture
  
  
• A puffy accumulation of air under the skin near the eye, usually a sign that the fracture has broken through the wall of a sinus cavity, particularly the maxillary sinus, an air-filled chamber located inside the cheek below the eye
  
  
• Swelling and deformity of the cheek or forehead, with an obvious dent over the area of broken bone
  
  
• An abnormally flat-looking cheek, and possibly severe pain in the cheek when you attempt to open your mouth
  
  

An orbital blowout fracture is a fracture or break in the small bones that make up your eye. The orbit, or eye socket, is the cavity of the skull that holds the eye. An orbital blowout can occur when an object strikes the orbit with blunt force. This injury is commonly the result of a fist, baseball or tennis ball that strikes 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 Treatment

Depending 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