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 healthcare providers will typically order a CT scan of the orbital area 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 healthcare provider can also visualize the sinus cavities. Many times when an orbital blowout fracture occurs, blood and fluid seep into the maxillary sinus cavity.
Symptoms
If you experience a blow to the eye, the following symptoms may indicate an orbital floor blowout:
History of eye traumaPain upon looking up and downTendernessSunken eyeDouble visionSevere eyelid and facial swellingNumbness of the upper cheek and gumSevere redness around the white part of the eyeNosebleed
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.
Treatment
Depending on the damage, most people who suffer an orbital blowout will require surgery. ER healthcare providers 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, facial plastics, or oculoplastics 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 healthcare provider to rule out eye-related complications, such as:
Orbital cellulitisAngle-recession glaucomaRetinal tear or detachment
