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Orbital Floor Fracture - Causes, Symptoms, Diagnosis, and Treatment

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Orbital floor fractures also called blowout fractures, are the most common type of midface fractures caused due to blunt force trauma.

Medically reviewed by

Dr. Atul Prakash

Published At October 5, 2022
Reviewed AtMarch 26, 2024

Introduction

Orbital floor fractures are the most common type of midface fractures. About 10 percent of facial bone fracture cases are reported to be orbital bone fractures. Primarily orbital bone fractures are often associated with other facial bone fractures, such as the zygomatic bone fracture, mandibular fracture, condylar process fracture, and frontal bone fracture. Orbital floor fractures are often known as blowout fractures and are characterized by inferior orbital rim fractures.

What Is an Orbital Floor Fracture?

An orbit is a pyramidal cavity in the frontal portion of the skull which contains the eyeball, several nerve supplies, lacrimal glands, and other structures that support the function of eyeballs. The cavity is surrounded by the bony walls: frontal bone, lacrimal bone, ethmoid bone, zygomatic bone, maxillary bone, palatine bone, and sphenoid bone. When an object equal to or larger than the circumference of the orbit hits the face or the eye region with greater blunt force, it fractures the orbital floor and the adjacent bony structures. This type of fracture is an orbital floor fracture called "a blowout fracture."

What Are the Common Causes of Orbital Floor Fracture?

Orbital floor fractures are more commonly seen in males than in females. People aged between 20 and 30 are more widely seen to report orbital floor fractures. A blunt force directed towards the mid-region of the face or the eye region leads to orbital floor fracture and injury to the soft tissues contained in orbit. Road traffic accidents, interpersonal violence, and sports injuries where a ball or a bat hits the orbital area at high speed are the most common scenarios that may lead to orbital floor fracture.

What Are the Common Signs and Symptoms of Orbital Floor Fracture?

The signs and symptoms presented by the patients with orbital floor fracture depend upon the bone fractured and the fracture's severity.

However, the common signs and symptoms presented by persons with orbital floor fractures are as follows,

  • Blurry vision.

  • Double vision.

  • Reduced vision.

  • Black or blue bruises around the eye region and in the cheeks.

  • Swollen forehead or cheeks.

  • Numbness in the injured side of the face might also be seen due to the injured nerve tissues.

  • Challenging to make eye movements like rolling the eyeballs up, down, left, or right.

  • Blood in the white part of the eye.

  • Protruded eyeballs (exophthalmia).

  • Sunken eyeballs (enophthalmos).

  • Severe pain in the cheeks.

  • Inability to open the mouth.

  • A flattened cheek on the side of the injury might be evident.

It is not that all the injured people will show all the symptoms mentioned above. The signs and symptoms vary from person to person.

How to Diagnose Orbital Floor Fracture?

The general physician or an ophthalmologist will diagnose orbital floor fracture by,

  • Taking a good history of trauma.

  • The general physician might ask the injured person to make specific eye movements like rolling their eyes up, down, left, and right. Any restricted movements in the eyeballs may indicate orbital floor fractures.

  • Radiographic imaging methods like X-rays. CT scans (computed tomography) can view the skull bones to detect fractures.

  • Examining the eyeballs for any eyeball protrusion or sunken eyeballs can denote orbital floor fracture.

  • A flattened cheek can also denote orbital floor fracture.

How to Treat Orbital Floor Fractures?

In most cases, after an orbital floor fracture, the fracture is allowed to be healed by itself without any surgical intervention. The person is advised not to blow their nose for a few days to avoid interruption in the healing process. In most cases, the double vision usually becomes normal after a few days. If double vision or protruded eyeballs (exophthalmos) or sunken eyeballs (enophthalmos) does not better as the fracture heals or if the condition worsens day by day, an ophthalmologist may refer an oculoplastic surgeon for further management.

The ophthalmologist and oculoplastic surgeon wait for a few weeks before moving on to surgical intervention. The injured person has usually prescribed steroids such as Prednisone to help with pain management, and antibiotics are prescribed to avoid further injury. Surgical intervention is made if visual impairments such as blurry vision or double vision, protruded eyeballs or sunken eyeballs persist even after the swelling around the fractured bone subsides. In some cases, the visual impairments reduce in a few weeks. Still, the patient might become uncomfortable with the protruded or sunken eyeballs, which might persist after curing other signs and symptoms. And in such cases, an oculoplastic surgeon helps regain the old appearance of the patient through surgical treatments.

How Can We Prevent Orbital Floor Fracture?

Orbital floor fractures are seen predominantly among men aged 20 to 30 and are more commonly seen to be caused due to sports injuries. The life of the person injured becomes complicated and the injury is a very painful fracture, and there are chances of a permanent asymmetrical face.

Occasionally, an orbital floor fracture heals in a few weeks or months without surgical intervention.

  • Sportspeople should use proper faceguards while playing to avoid injuries.

  • Proper and consistent head helmets must be used to avoid fractures and other life-threatening complications that might be caused due to road traffic accidents.

Conclusion

Proper diagnosis and treatments can help with the betterment of the person injured. However, most of these types of fractures are caused due to carelessness among the young generation and interpersonal violence. Hence, proper precautions and patience can help avoid injuries and fractures that might lead to lifelong complications and problems. As the old saying says, "It takes minutes to break a bone, but it takes months or even years to heal a broken bone." So, "Prevention is always better than cure."

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Dr. Atul Prakash
Dr. Atul Prakash

Orthopedician and Traumatology

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