A broken eye socket usually causes intense pain, swelling, and a black eye, which make it easy to diagnose.
The eye socket is the bony structure surrounding and protecting the eye. In addition to the eye, it houses all the muscles, nerves, and connective tissues that connect to and move the eye.
Some parts of the eye socket are hard, thick, and difficult to break. Other areas are fragile and more prone to breaking.
In this article, we look at the symptoms of a broken eye socket, as well as the different types of fracture that can occur. A broken eye socket always requires medical attention, but treatment and recovery times can vary according to the severity of the break.
The eye socket is also called the orbit. While it feels like one solid structure, it consists of seven different bones that connect to create four different areas.
A fracture can occur in any one of these areas, creating different injuries:
- Orbital rim fracture. These breaks occur in the outer edges of the eye socket. The orbital rim is very thick, so only extreme force, such as an injury from a car accident, can break it. This extra force can also injure the nerves, muscles, and connective tissues in the eye.
- Direct orbital floor fracture. An orbital rim fracture may extend to the orbital floor to cause a direct orbital floor fracture. This will usually occur as a result of severe trauma.
- Indirect orbital floor fracture. Also called a blowout fracture, an indirect orbital floor fracture typically occurs when an object, such as a steering wheel, fist, baseball, or elbow hits a person in the face. The impact leaves the bony rim of the socket intact but causes a hole in the floor of the eye socket. This hole can trap muscles, nerves, or other tissues, which makes it difficult for the eye to move and causes vision problems.
- Trapdoor fracture. Trapdoor fractures generally only occur in children because their bones are more flexible. They are a type of orbital floor fracture. Instead of fracturing, the bones flex outward, then return to their normal position. While not technically a bone break, trapdoor fractures can still lead to severe and sometimes permanent damage.
The main symptom of a broken eye socket is pain around the eye. Depending on the type of fracture and its severity, the additional symptoms below may also occur:
- eyelid swelling
- a black eye with very dark discoloration around the injury
- bleeding in the white of the eye
- numbness in the cheeks, forehead, or upper lip area
- double vision, blurred vision, or difficulty seeing
- inability to move the eye
- a drooping eyelid
- sensitivity to light
- a sunken or bulging eye
- a flattened cheek, usually making it painful to open the mouth
- a pocket of air under the skin near the eye
- nausea and vomiting, in the case of trapdoor fractures
Accidental injuries are the most common overall cause of eye socket fractures. Fractures to the thicker bones in the eye socket may be more common following traumatic events, such as falling from a height or having a car accident.
Sports injuries can cause a broken eye socket, especially sports where a ball or stick can hit the face. Using tools such as hammers, drills, and power saws may also increase a person's risk of eye injuries.
Other causes include physical assaults and fighting. A punch or kick in the eye may be enough to lead to an indirect floor fracture if the pressure on the eye is too much for the thin bone to withstand.
In most cases, a doctor will make an initial diagnosis after physically inspecting the eye. They may also check eye pressure and ask questions about the person's vision, such as whether the eye can look in all directions.
To help confirm the diagnosis, doctors use imaging tests like X-rays and CT scans.
The individual may need referring to a specialist to ensure that they receive comprehensive treatment. For example, an ophthalmologist can help diagnose vision damage, and a neurologist can advise on any nerve damage.
Many broken eye sockets heal without surgery. If doctors believe that the fracture can heal naturally, they may recommend some complementary treatments, including antibiotics to prevent infections and special nasal sprays to stop the person sneezing.
Other tips to help people feel more comfortable while the eye socket heals include:
- sleeping with the head elevated on extra pillows
- taking care not to strain while lifting, pushing a heavy object, or having a bowel movement
- taking over-the-counter (OTC) pain medications, such as ibuprofen (Advil) or acetaminophen (Tylenol)
- wrapping ice packs in cloth and placing them on the area to reduce swelling
Doctors may also recommend that people avoid sneezing or blowing their nose while the eye socket is healing. These actions can put unnecessary pressure on the fracture and may spread bacteria from the sinuses to the injured eye socket.
While the swelling and bruising may start to improve after a week or so, the fracture can take much longer to heal. Recovery time varies greatly depending on how severe the fracture is and whether or not there are any infections or other complications.
Treating a broken eye socket with surgery
Surgery for a broken eye socket can be risky and is not always the best treatment method. If surgery is necessary, the surgeon may wait a few weeks until the swelling in the eye reduces.
Specific symptoms that may require surgery include:
- an eye that is still pushed back into the eye socket after several weeks of healing
- signs of lasting facial deformity
- double vision or other vision changes that persist after the swelling goes down
A reconstructive surgeon that deals with eye injuries may perform the surgery. Depending on the specific fracture, the surgical procedures may include:
- freeing trapped muscles, ligaments, or nerves
- removing bone fragments
- restructuring the eye socket
- repairing deformities
It is not always possible to prevent accidents, but taking measures to protect the eyes and face may help reduce the chances of breaking the eye socket. Preventative measures include:
- wearing protective eyewear when doing house repairs
- wearing a protective mask when playing ball sports
- wearing a seatbelt in the car
- keeping the head against the headrest and far from the airbag while driving
- using protective goggles when shooting firearms or working with explosives or pressurized items
- wearing protective gear when working in a dangerous area, such as a construction site, shooting range, or driving range
Anyone experiencing symptoms of a broken eye socket should seek immediate medical attention. With proper treatment, the outlook for eye socket fractures is good.
Even when surgery is necessary to repair a fracture, it is likely that the fracture will heal without long-term complications.