Specialist Management of Eye Socket Injuries
Orbital fractures involve the bones surrounding the eye (orbit) and can affect vision, eye movement, and facial structure.
These injuries require careful assessment to determine whether treatment is needed to restore both function and appearance, particularly where the eye itself is affected.
Understanding the Orbit
The orbit is a complex bony structure that:
- Houses and protects the eye
- Supports eye movement
- Contributes to facial contour
It is formed by thin bones that are vulnerable to injury, particularly in:
- Sports trauma
- Falls
- Road traffic accidents
- Interpersonal injury
Types of Orbital Fractures
Orbital Floor Fractures (“Blowout Fractures”)
- The most common type
- Involve the thin bone beneath the eye
- May allow soft tissue or muscle to become trapped
Orbital Rim and Complex Fractures
- Involve the stronger outer edges of the orbit
- Often occur with broader midfacial injuries (e.g. zygomatic fractures)
How Orbital Fractures Present
Symptoms may include:
- Swelling and bruising around the eye
- Double vision (diplopia)
- Pain on eye movement
- Restricted eye movement
- Sunken appearance of the eye (enophthalmos)
- Numbness of the cheek or upper lip
- Reduced visual acuity (less common but urgent)
Visual symptoms always require prompt assessment.
Assessment
Assessment is focused on both eye function and skeletal injury.
This includes:
- Examination of vision and eye movements
- Assessment for double vision
- Evaluation of globe position (eye level and symmetry)
- CT imaging to define fracture pattern and soft tissue involvement
In some cases, ophthalmology input is required.
When Treatment Is Required
Not all orbital fractures require surgery.
Conservative Management
Appropriate where:
- Minimal symptoms
- No significant double vision
- No muscle entrapment
- No cosmetic deformity
Management includes observation and follow-up.
Surgical Management
Surgery is indicated where there is:
- Persistent or significant double vision
- Evidence of muscle entrapment
- Sunken or displaced eye position
- Large defects affecting orbital volume
Surgical Treatment
Surgery involves:
- Releasing any trapped tissue or muscle
- Reconstructing the orbital floor or wall
- Restoring normal orbital volume and eye position
This is typically achieved using:
- Specialised orbital implants or grafts
- Precise anatomical reconstruction
Access is usually through:
- Incisions hidden inside the eyelid
- Or just beneath the eyelashes where necessary
The aim is to restore:
- Eye movement
- Visual function
- Facial symmetry
Timing of Surgery
Timing depends on the injury:
- Urgent surgery may be required for muscle entrapment
- Other cases may be addressed within 1–2 months once swelling settles
- Early treatment improves functional and cosmetic outcomes
Recovery
Recovery varies depending on severity.
- Swelling and bruising are common initially
- Eye movement improves over time
- Double vision often resolves gradually
- Final contour and symmetry settle over several weeks
Patients are advised to:
- Avoid nose blowing in early recovery
- Avoid activities that increase pressure in the sinuses
Outcomes
With appropriate treatment, outcomes typically include:
- Restoration of eye movement
- Resolution or improvement of double vision
- Normalisation of eye position
- Good cosmetic symmetry
Some minor residual symptoms may persist in more complex cases.
Risks and Considerations
Potential risks include:
- Persistent double vision
- Residual asymmetry or contour irregularity
- Infection or implant-related complications (uncommon)
- Visual disturbance (rare but serious)
Careful planning and surgical precision minimise these risks.
Specialist Assessment and Treatment
Orbital fractures require integration of:
- Skeletal reconstruction
- Ophthalmic assessment
- Functional restoration of eye movement
As a dual-qualified (medical and dental) Consultant Maxillofacial Surgeon, treatment is guided by:
- Detailed understanding of orbital anatomy and biomechanics
- Experience in midfacial trauma and reconstruction
- Close coordination where required with ophthalmology
- Focus on restoring both function and facial balance
When to Seek Assessment
Assessment is required if you have:
- Double vision
- Pain on eye movement
- Reduced vision
- Significant swelling around the eye following trauma
These may indicate an orbital injury requiring specialist care.
Consultation
Assessment includes examination, imaging, and discussion of whether treatment is required.
Book a Consultation
For assessment and management of orbital fractures in London, arrange a consultation to discuss your injury.