Blowout fractures are breaks in the bones surrounding the eye. When a person experiences force or trauma to the eye area, it can cause the thin bones of the compartment that holds the eye to break.

Symptoms may include bruising, swelling, redness, and double vision, among others. Most blowout fractures do not require surgery, but some types may need surgical repair.

In this article, we will discuss the types and symptoms of blowout fractures, as well as the available treatments.

A soccer playing lying on the ground in pain due to a blowout fracture.Share on Pinterest
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A blowout fracture is a break in one of the bones surrounding the eye area.

The orbit is the concave compartment that protects the eye and holds it in place. If a person takes a blow to the eye area, the thin bones of the orbit may be the first to buckle or break.

The bone of the orbital floor often fractures because it is the thinnest of the eye bones. Absorbing the force in this area may actually protect the eye from more serious injury.

The muscles, fat, and connective tissue of the eye may also bruise or become displaced. With less of this tissue filling the socket, the eye can sink back, resulting in cosmetic and functional eye problems. A person may experience double vision if the fracture affects the eye muscles and changes how the eye moves.

Doctors classify blowout fractures according to several features, including:

  • how big they are
  • where they are
  • whether the trauma has displaced the bone
  • whether muscle or other tissue is trapped in the fracture
  • what symptoms a person has, such as double vision, pain, or altered eye position

Simple blowout fractures cause minimal or no double vision and minimal or no loss of tissue in the eye compartment once the initial swelling goes down.

However, people can experience a more problematic type of orbital fracture known as a “trapdoor fracture” or “white-eye fracture.” Children are more susceptible to this type of fracture because their bones are more elastic than adults’ bones.

Trauma to the eye creates a hinged bone fragment that opens like a trapdoor and allows muscle or other soft tissue to escape. The trapdoor then snaps shut and cuts off the blood supply to the tissue trapped inside, restricting eye movement.

The most common symptoms of a blowout fracture are:

  • bruising, tenderness, and swelling around the eye
  • eye redness
  • double vision, or diplopia
  • numbness of the cheek, nose, or teeth

A person with a trapdoor fracture may also show signs of trapped soft tissue, such as:

  • limited ability to gaze upward
  • pain when moving the eye
  • nausea or vomiting

Nausea and vomiting can occur because of the oculocardiac response. This is a reflex that becomes activated when there is pressure on the eye muscles. This causes the heart rate to slow down, blood pressure to fall, and nausea or vomiting to set in.

Nausea and vomiting are a sign of trapdoor fracture in 75% of cases.

A blowout fracture is the result of a blunt force directed at the eye with or without pressure toward the eye rim. This increases pressure inside the orbit and fractures its bony structures.

Common events that can result in blowout fractures include:

  • falls
  • playing high velocity ball sports
  • traffic accidents
  • interpersonal violence

To diagnose a blowout fracture, a doctor will first take a person’s medical history and perform a physical examination. They will ask the person what caused their injury and whether they are experiencing numbness, double vision, or other problems with seeing clearly.

Imaging scans can help shed light on the injury. For instance, CT scans may show muscle or fat rupturing into the maxillary sinus, which is a hollow space in the bones around the nose, or torn or trapped tissue.

X-rays can also show air trapped in the tissue under the skin and the air-to-fluid level in the maxillary sinus.

Treatment for a blowout fracture depends on the type and severity of the break. Most blowout fractures do not require surgery and do not cause lasting problems.

For simple blowout fractures, the treatment involves:

  • applying ice to reduce swelling
  • taking decongestants to drain blood and fluid in the sinuses
  • avoiding blowing the nose while it is healing

Blowing the nose creates pressure that could push the blood and fluid in the sinuses into the orbit.

In some cases, a person with a simple fracture may need steroids to reduce swelling or the risk of scarring. If a person gets an infection, they will need oral antibiotics.

If the symptoms do not improve, a doctor may recommend surgical repair. Surgery can reposition bone or protect the broken bone via an implant that covers it. In cases of trapdoor fracture, a person needs surgery to release the tissue within 24–48 hours.

If double vision persists, a person may benefit from prism glasses or botulinum toxin injections on the eye muscles.

Below are answers to frequently asked questions about blowout fractures.

How common are blowout fractures?

More men than women experience blowout fractures. They are most common in men aged 21–30 years. The orbital floor and the medial orbital wall, which is the side of the eye compartment nearest the nose, are the most common fracture sites.

How serious are blowout fractures?

A cross-sectional study from 2020 examined 203 cases of blowout fracture and found that 53% were mild. However, they can range in severity depending on the extent and location of the injury.

Are there long-term complications?

Yes, blowout fractures can sometimes result in complications. This includes lasting vision problems, infections, or displacement of the eye.

Complications can also arise from surgery, including displacement and scarring of the lower eyelid. If a person needs an implant and the surgeon does not place it correctly, this can result in tissue herniation.

Anyone who has received a blow to the eye area should speak with a doctor as soon as possible. If a person has any of the following symptoms after such an injury, they should dial 911 or go to the nearest emergency room:

  • nausea
  • vomiting
  • difficulty looking upward
  • pain when moving the eye
  • severe double vision

A person should also speak with a doctor if their fracture or vision changes are not getting better, or if they have symptoms of infection, such as swelling, pus, or fever.

Only a doctor can determine which type of eye injury a person has. Seek a thorough medical evaluation to prevent long-term problems.

A blowout fracture is a break in one of the bones of the eye’s orbit. Symptoms can include pain, double vision, and problems moving the eye. The fracture can vary in size and exact location.

Depending on the severity and type, a blowout fracture may get better on its own, but some people may need urgent surgery. For this reason, anyone who is concerned that they or a child has a fracture around the eye should seek medical help.