Fractured Orbit

The orbit (or eye socket) is the name given to the cavity containing the eye (globe) and its supporting structures (fat, muscles, blood vessels etc).

Fractures of the orbit may result in blindness or impaired vision, altered sensation over the cheek, pain, bleeding into the maxillary sinus with drainage of blood from the nose and an alteration in facial symmetry.

Orbital fractures may occur alone or in combination with other fractures of the facial skeleton (most commonly the zygomatic complex (cheekbone).

The most important assessment in trauma to the orbit is whether there has been, or is likely to be blindness or altered vision as a direct result of the injury or due to changes occurring as a result of the injury.

Swelling in the first 7 – 10 days often makes surgery difficult and it is not uncommon to delay intervention until this initial period of acute injury has passed. This may also allow better assessment of whether surgical reconstruction is required. This is the reason you may not be offered an appointment with your surgeon until a few days after the injury, particularly if your referring doctor has determined there is no risk to your vision.

A CT scan is mandatory to assess the location and extent of the fracture and helps guide your surgeon as to whether reconstruction is necessary.

Surgery to reconstruct a fractured orbit is generally undertaken with incisions in the conjunctiva (mucosa beneath the lower eyelid) and does not result in a visible facial scar. Depending upon the injury it may be necessary to place an implant eg titanium mesh beneath the orbital contents to reconstitute the orbital cavity. These implants are not removed and are quite safe in the longer term.

Following surgery swelling is again a feature and may result in double vision that generally settles as the swelling around the eye resolves. Sensation to the cheek usually improves but will usually take months.

Follow-up is required in the postoperative period and depending upon the injury and progress following surgery may be required for up to 6 months.