Understanding what causes these fractures can help explain why certain symptoms develop and why some injuries require faster treatment than others. The structure of the eye socket plays a direct role in how and where fractures occur.
The most common cause of an orbital fracture is a direct blow to the eye or cheekbone. This can happen from a fist, an elbow, a sports ball, a fall, or a motor vehicle accident. The force of the impact travels through the soft tissue of the eye and into the thin bones of the socket.
The orbital floor, the bone beneath the eye, is the thinnest wall of the socket and breaks most frequently. Sports injuries and falls are among the most common causes in both adults and children.
Not all orbital fractures are the same. A blowout fracture breaks the orbital floor or the inner wall while leaving the thicker bone rim at the edge of the socket intact. A rim fracture involves that outer bony edge and typically results from higher-force impacts. Complex fractures can involve multiple walls and may extend into surrounding facial bones.
The type, size, and location of the fracture guide whether surgery is needed and how quickly it should happen. Our eye doctors classify each fracture carefully using imaging and a full clinical evaluation.
When the orbital floor breaks, bone fragments can shift and trap the inferior rectus muscle, the muscle below the eye, or the surrounding tissue in the fracture gap. This entrapment physically blocks the eye from moving upward and causes double vision when looking straight ahead or downward.
In children especially, trapped muscle tissue can lose blood supply within hours. This is why restricted eye movement after facial trauma in a child is treated as an emergency, even when the injury looks mild on the outside.
A thorough evaluation after facial trauma includes imaging, eye movement testing, and a complete eye exam. Our eye doctors take a careful approach to make sure no injury is missed before recommending a treatment plan.
A CT scan with thin image slices in multiple planes is the standard imaging study for diagnosing orbital fractures. It shows the exact location and size of the fracture, whether tissue or fat has herniated into the sinus below, and whether muscle entrapment is present.
Standard X-rays are not reliable for orbital fractures and cannot provide the detail needed for surgical planning. When clinical signs suggest a fracture, especially in a child with limited eye movement, a CT scan is ordered promptly.
Our eye doctors assess how well both eyes move in all directions. Restricted upward movement in the injured eye, particularly when accompanied by pain, suggests that the inferior rectus muscle is involved. A test called forced duction testing, in which the eye is gently guided with an instrument after numbing drops are applied, can confirm whether the limitation is mechanical from entrapment or caused by nerve or muscle bruising.
The degree of double vision in different gaze positions is also measured. This information helps determine whether the restriction is likely to improve on its own or whether surgical repair is needed.
Orbital fractures are rarely isolated injuries. A complete eye exam checks for other damage that may need attention alongside the fracture itself.
Hyphema, a collection of blood inside the front part of the eye, and globe rupture, a break in the outer wall of the eyeball itself, are among the more serious associated injuries that require immediate treatment. Cheek numbness from infraorbital nerve involvement is common with floor fractures and often improves gradually over weeks to months.
Treatment depends on the size of the fracture, whether muscle entrapment is present, and how the injury is affecting your vision and eye position. Some fractures heal well without surgery, while others require prompt repair.
Small fractures without muscle entrapment, significant double vision, or a sunken eye appearance may heal without surgery. Conservative management typically includes a short course of antibiotics to reduce the risk of sinus infection spreading to the orbit, cold compresses to manage swelling, and strict instructions to avoid blowing your nose for several weeks.
Follow-up visits at one to two weeks allow our eye doctors to monitor healing and watch for late-developing complications such as delayed enophthalmos, which can appear after swelling fully resolves and the true position of the eye becomes apparent.
Surgery is typically recommended when the eye appears sunken by more than two millimeters, double vision in primary or downward gaze persists, muscle entrapment is confirmed, or the fracture involves more than half of the orbital floor. In adults, surgery generally takes place within one to two weeks of injury, allowing initial swelling to settle while preventing scar tissue from forming.
Children with confirmed muscle entrapment may need surgery within 24 to 48 hours to prevent permanent muscle damage. During the procedure, the surgeon frees any trapped tissue and places an implant, made from materials such as titanium mesh or porous polyethylene, to reconstruct the orbital floor. The incision is typically made inside the lower eyelid or just below the lash line. Most patients go home the same day.
Swelling and bruising are usually most noticeable two to three days after surgery and then gradually improve over two to three weeks. Sleeping with your head elevated, avoiding nose-blowing, and limiting strenuous activity for several weeks are standard recovery instructions.
Double vision often improves over weeks to months as swelling resolves and the eye muscles regain their full range of motion. Some patients may need prism glasses, which are special lenses that help align images, or additional treatment if double vision persists well after healing is complete.
Most patients with orbital fractures recover well, but the timeline varies depending on the severity of the injury. Knowing what to expect and how to protect your eyes going forward helps you heal with confidence.
Visible swelling and bruising typically improve significantly within two weeks. Double vision may take several weeks to several months to fully resolve, particularly in cases where muscle entrapment was present. Cheek numbness caused by infraorbital nerve irritation often improves gradually over months, although it may be permanent in some cases.
Our eye doctors monitor your eye alignment, vision, and the overall appearance of the orbit at scheduled follow-up visits. Additional surgery is rarely required but remains an option if significant double vision or enophthalmos persists after full healing.
After an orbital fracture, protecting the affected eye is important, especially when returning to sports or physical activity. Polycarbonate sport goggles or a face shield provide the best protection during contact sports, racquet sports, or any activity with a risk of facial impact. Standard eyeglasses do not provide adequate protection from orbital injury during these activities.
If you have had a previous orbital fracture, talk with our eye doctors about appropriate activity restrictions and when it is safe to return to full participation. The specifics will depend on how your repair healed and what materials were used.
Some symptoms after an orbital fracture require prompt attention. Contact our office or seek emergency care right away if you experience any of the following.
These symptoms may point to a complication such as infection, implant displacement, or a missed injury that needs evaluation. Keeping all scheduled follow-up appointments gives our team the best opportunity to catch any concerns early.
The following questions address common concerns that patients often have after an orbital fracture diagnosis.
Whether double vision resolves depends on what is causing it. If it is primarily due to swelling around the muscles rather than true entrapment, it often improves within a few weeks as swelling goes down. More complex fractures with confirmed muscle involvement can take several months to improve, and in some cases, prism glasses or additional treatment may be needed. This is why follow-up visits are important even when you feel like you are recovering well.
In most cases, our eye doctors recommend avoiding nose-blowing for at least two to four weeks, though the exact timeline depends on the size of the fracture and how healing progresses. Resuming too early can push air into the eye socket and worsen swelling or cause other complications. You will receive specific guidance at your appointment and at each follow-up visit.
In most cases, the incision is placed either inside the lower eyelid or just below the lash line in a natural skin crease. Both approaches are designed to minimize visible scarring. Most patients heal with little to no visible scar. Your surgeon will explain the approach that is appropriate based on the specific location and extent of your fracture.
Yes. In children, a near-normal appearance does not rule out a serious underlying fracture. A white-eyed blowout fracture can trap the eye muscle without much external bruising or swelling. Restricted upward gaze combined with nausea, vomiting, or pain in a child after facial trauma should be evaluated in an emergency setting without delay, because the window for preventing permanent muscle damage is very narrow.
Yes, in some cases. Even fractures managed conservatively can lead to late complications, most commonly delayed enophthalmos, where the eye sinks back as post-injury swelling fully resolves. That is why follow-up visits scheduled at one to two weeks and beyond are not optional, even when you feel well. Catching a late change in eye position or worsening double vision early gives you the best chance of addressing it with less intervention.
Glasses that rest on the nose are generally fine after an orbital fracture, but applying pressure around the eye or inserting contact lenses should be discussed with your eye doctor first. Inserting contacts requires touching the eye and eyelid area, which may not be advisable while healing. Your eye doctor will let you know when it is safe to resume your normal lens routine based on your specific injury.
Facing an eye injury is stressful, and getting the right evaluation quickly can make a real difference in your outcome. At NewView Eye Center, our eye doctors bring focused expertise and genuine care to every patient who walks through our doors in Northern Virginia. We are here to guide you through every step of your recovery, from the first exam to full healing. We encourage you to contact us right away if you or someone you love has experienced facial trauma with any of the symptoms described on this page.
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