Introduction

Any fracture that takes place in the eye orbital area is known as orbital fracture. The upper periphery of the orbit of the eye is made up of thick bones. The lower half of the periphery of the eyes and the nasal portion is made up of the thinner bones. Overall the eye structure is delicate and orbital fractures can take place anywhere in the orbital area which includes the two halves of the periphery and the nasal area as well. Statically, 8 out 10 cases of orbital injuries are cause due to high intensity automobile crashes or occupational hazards. It has been observed that more men suffer from orbital fractures as compared to women. But as more and more cars have airbags, there has been a slight decrease in the number of patients with severe orbital fractures.

Different types of orbital fractures:-

Depending upon the location where the fracture takes place, orbital fractures can be of the following types:-

  • Indirect orbital floor fracture: – This type of fracture is also known as blowout fracture. This type of fracture causes the floor of the orbit to crack or rupture. However, the upper half of the socket remains intact. This crack can cause a minor opening in the floor of the socket which may cause the ocular structures to get stuck or tangled. This restricts the movement of the injured eye and may cause the patient to have problems with vision. Generally, things that are larger than the size of the eye may cause this type of fracture.
  • Direct orbital floor fracture: – This type of fracture extends through the rim to the floor to the eye socket. It generally originates at the rim of the eye socket.
  • Orbital rim fracture: – They are most commonly occurring facial bone fractures and generally are caused by high intensity impact crashes. Most automobile accidents cause orbital rim fractures in the victims. Orbital rim fractures are often accompanied by other facial fractures also. This type of fracture causes multiple damages to the ocular area which may cause damage to the optic nerve, tear duct, eye muscles etc.

Orbital rim fractures can be further divided into two categories:-

  • Frontal bone or the frontal sinus fractures- As the name suggests this type of fractures on the frontal bone of the forehead which is a part of the upper portion of the eye socket.
  • Zygomatic fracture- This type of fracture affects the zygomatic complex of the face that is the area around the cheekbones.

What are the symptoms of orbital fractures:-

  • Bleeding inside the eyelids and the white portion of the eyes.
  • Problem with vision, blurry or double vision is quite common.
  • Area of severe discoloration around the eyes.
  • Evident abnormality in the position of the eyes. The eyes may seem to be dislocated, sunken in or cold be bulging out as well.
  • As various nerves form a part of the entire ocular structure, when an orbital fracture takes place there may be some numbness in the upper lips, cheeks, forehead etc.
  • The under eye area may become puffy due to air which may enter through a cavity formed due to fracture in sinus wall.
  • Severe facial pain.
  • Excessively swollen forehead and cheeks.

Diagnosis:-

The first step is the physical diagnosis in which the surgeon looks for obvious signs of physical damage. The doctor will look for damage by touching various areas of the face. If the patient is not able to look up or down this may indicate trapped muscles in the fractures areas of the socket. The intensity of the fracture and the exact locations of the fracture may be diagnosed with the help of MRI or CT scan. Sometimes the injury may extend to the brain in which case the patient may become unconscious. The brain injury may check for by various imaging tests.

Recovery and prevention:-

The rate of recovery for each patient of orbital fracture will depend upon the severity of the fracture. A minor fractured eye socket may not take very long to heal while a severe case of fracture may take several months to heal completely.

The only way to prevent orbital fractures is to be cautious. As mentioned earlier, automobile mishaps happen to be one of the largest causes of the orbital fractures. Therefore, it is very important to be safe while driving and it is also important to wear safety belts while in the car. For people who play high intensity sports like baseball, cricket etc. it is imperative to wear safety helmets while playing. Some professions also pose high risk of orbital fractures. People in such professions should wear all the recommended and mandatory safety equipment to protect themselves from any grave injuries. Small safety measures can go a long way in preventing orbital fractures.


About Dr. Debraj Shome

Debraj Shome-2
Debraj Shome, MD, DO, DNB, FRCS (Glasgow), FICO (USA), MNAMS, MBA (Healthcare Management, Vanderbilt University, USA), is Consultant Facial Plastic Surgeon, Oculoplastic Surgeon & Cosmetic Surgeon at Nova Specialty Surgery, Mumbai, India..Read more

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