The bony cup surrounding the eye is the eye socket or orbit. The socket consists of seven bones fused.
The socket is responsible for holding the eyeball in position with the help of the associated muscles, ligaments, blood vessels, nerves, and tear glands within it.
The various bones forming the eye socket are divided into four parts. In a fracture, either of these parts can be involved:
A part of the cheek (zygomatic) bone, upper jawbone (maxilla), and a small portion of the palatine bone (hard palate) form the orbital floor or the inferior wall. Fractures to the inferior wall generally are because of a blow to the side of the face. The Source of the blow could be a car accident for example.
The zygomatic bone extends to form the outer or the sidewall of the eye socket. This is prone to fracture by a blow to the side of the face. This portion contains important nerves that run through it.
The ethmoid bone, which separates the brain from the nasal cavity mostly, forms the medial wall of the eye socket. A blunt hit to the nose is the most common reason for medial wall fractures.
The frontal bone of the forehead forms the roof of the orbit. Fractures to this bone are less common.
Studies have shown, 28 percent of orbital fractures have been reported with affected vision.
There are three types of fractures depending on the bones involved:
Orbital rim fracture.
Trapdoor fractures (common in children).
Eye socket fractures are characterized by the following symptoms:
Swollen or droopy eyelid.
Bruise, tear, or bleeding near the eye.
Reduced or double vision.
Hindrance in eye movement.
Nausea and vomiting (observed in association with trapdoor fracture).
The eye is evaluated in a physical examination and the pressure to is evaluated. Increased pressure could lead to damage to the optic nerve and subsequent loss of vision.
X-rays help determine the position of the fracture.
Damage to the vision or movement of the eye will need the involvement of an eye doctor (ophthalmologist) and that to the roof of the orbit, will need a neurosurgeon to assess the extent of damage and its consequences. These consultations are important for effective treatment management of the fracture injury.
For less severe fractures, the doctor may prescribe medications to avoid infections and outline precautions to allow the fracture to heal on its own.
However, severe debilitating fractures will need surgical intervention. In this case, the surgeon will wait for the swelling associated with the fracture to subside to have a better assessment of the extent of the damage.
The surgery is performed under general anesthesia, so the patient is asleep during the surgery.
Under the usual approach of the surgery, a small incision is made on the inside of the eyelid and the outside corner of the eye. Endoscopy too may be used to insert a small camera and surgical instruments through the small incisions made in the nose and mouth and the reconstruction performed thereafter.
An overnight stay or maybe a little longer depending on the patient's response to treatment is expected after the surgery.
Ice fomentation along with antibiotics, painkillers, and immune system suppressant drugs will be prescribed to help aid recovery.
The patient is recommended to abstain from strenuous activities, including blowing the nose for about two to three weeks.
Post-surgery the doctor will schedule the patient for a couple of visits to evaluate the surgery and recovery.
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