Orbital fracture: first signs, first aid, treatment and consequences

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Violation of the integrity of the orbital walls is typical mainly for people in the age category from twenty to forty years. The seriousness of such injuries lies in the fact that the consequences of a fracture of the orbit are very dangerous for human health, since in most cases they lead to loss of ability to work and disability of the patient. The severity depends on the condition of the adjacent paranasal sinuses and the brain.

Photo: characteristic features of a broken eye socket in a person

Etiopathogenesis of injury and its symptoms
Possible consequences of a damaged eye socket
How to treat and recover from an orbital fracture

Structure of the eye socket

The orbit has four walls, firmly attached to each other: upper, lower, outer and inner. Since the eye socket is pyramidal in shape, it also has a base and an apex. The base is located closer to the outer part of the skull, and the opposite side of the orbit goes deep into the orbital fissure, where it connects with the optic nerve canal.

Structure of the eye socket:

The upper wall is formed by the frontal bone and is adjacent to the anterior cranial fossa. Inside the frontal bone is the frontal sinus. For this reason, if inflammation occurs in this sinus, it spreads to the eye.
The lower wall is formed by part of the upper jaw. It also borders on the sinus, but on the maxillary sinus; the inflammatory processes that arise in it easily begin to spread to the organ of vision.
The outer wall suffers least often, since it consists of three bones of the orbit: the sphenoid, zygomatic and frontal and is the most durable.
The inner wall has the most fragile structure. This is due to the ethmoid bone, which forms this part of the orbit. To break the integrity of the wall, a slight blow with a blunt object is enough. Damage to bone tissue and the eyelid leads to the entry of air, resulting in the formation of a soft tumor; upon palpation, the movement of air is clearly felt and a crunching sound is heard. The inflammation that occurs in this area easily spreads to the orbital cavity.

The eyeball has many nerves and vessels extending from it; for this reason, the bone tissue of the orbital cavity is dotted with holes.

Fractures of the walls of the orbit

Statistics
Etiology
Anatomical features of the orbital walls
Classification and diagnosis of orbital fractures
Diagnostics
Clinical picture
Diagnostics

An orbital fracture is a complete or partial disruption of the integrity of the walls of the orbit under a load exceeding the strength of the injured area. Fractures can occur either as a result of trauma or as a result of various diseases accompanied by changes in the strength characteristics of bone tissue.

Isolated fractures of the superior and lateral walls of the orbit are rare and are usually associated with other fractures of the facial skeleton. Thus, fractures of the lateral wall are usually combined with fractures of the zygomatic or sphenoid bones, and fractures of the orbital roof are usually combined with damage to the upper edge of the orbit, frontal bone and frontal sinus.

Statistics

Damage to the orbit mainly occurs during the first thirty years of life and, among other orbital pathologies, is second in frequency only to endocrine ophthalmopathy in adults and dermoid tumors in children. Of all orbital injuries requiring hospital treatment, about 85% are fractures of its walls.

Orbital fractures are one of the most common injuries to the midface, second only to injuries to the nasal bones. According to P. Siritongtaworn et al (2001), orbital fractures account for 40% of all facial skeleton fractures. Three quarters of the victims are men.

Isolated orbital fractures occur in approximately 35–40% of cases; in 30–33% of victims, two walls are damaged. Fractures of three orbital walls are recorded in 15–20% of patients and all four in 5–10% of cases.

In children, orbital fractures account for 23% of all facial injuries, second only to fractures of the mandible (34%). In turn, of all orbital fractures encountered in pediatric practice, from 25 to 70% are injuries to the lower wall in the “trap” type fracture. It is important to note that orbital fractures, as a rule, are combined with certain injuries to the eyeball, including penetrating wounds and subconjunctival ruptures of the sclera. According to C. Ioannides et al. (1988), T. Cook (2002), damage to the eye or periocular soft tissues occurs in 26% of patients with orbital fractures, but conditions requiring ophthalmic surgical care are observed much less frequently - in 6.5% of cases.

Etiology

The main mechanisms of damage to the orbit are road traffic accidents (RTA) and criminal trauma (each of these causes accounts for 40% of fractures). Injuries are often the result of sports activities. For example, in Italy, Australia, and New Zealand, sports injuries account for 15–20% of facial bone fractures. Isolated cases of a fracture of the lower wall of the orbit as a result of forced nose blowing have been described.

Anatomical features of the orbital walls

The upper wall of the orbit, the “roof of the orbit,” borders the cranial cavity and is formed almost along its entire length by the frontal bone and only posteriorly by a small portion of the lesser wing of the sphenoid bone. On the nasal side, the upper wall of the orbit borders the frontal sinus (sinus frontalis), located in the thickness of the frontal bone. Trauma to the upper wall of the orbit entails the most severe consequences and should be regarded not only as orbital, but also as craniocerebral.

The thickest and strongest of them is the lateral wall (paries lateralis), formed in its anterior half by the zygomatic bone, and in the posterior half by the orbital surface of the greater wing of the sphenoid bone. The length of the lateral wall from the edge of the orbit to the superior orbital fissure is 40 mm.

The longest (45 mm) medial wall (paries medialis) is formed (in the anteroposterior direction) by the frontal process of the maxilla, the lacrimal and ethmoid bones, as well as the small wing of the sphenoid bone. Its upper border is the frontoethmoidal suture, the lower border is the ethmoidomaxillary suture. Unlike other walls, it has the shape of a rectangle. The medial wall of the orbit separates the orbit from the nasal cavity, ethmoidal labyrinth and sphenoid sinus. This circumstance is of great clinical importance, since these cavities are often a source of acute or chronic inflammation, spreading per contuitatem to the soft tissues of the orbit. This is facilitated not only by the insignificant thickness of the medial wall, but also by the natural (anterior and posterior ethmoidal) openings in it.

The lower wall (paries inferior), which is the “roof” of the maxillary sinus, is formed mainly by the orbital surface of the body of the upper jaw, in the anterior outer section - by the zygomatic bone, in the posterior section - by a small orbital process of the perpendicular plate of the palatine bone. The lower wall is the only one in the formation of which the sphenoid bone does not take part. The lower wall of the orbit has the shape of an equilateral triangle. It is the shortest (about 20 mm) wall, not reaching the apex of the orbit, but ending with the inferior orbital fissure and the pterygopalatine fossa.

The frontal plane, drawn through the equator of the eyeball, divides the orbital cavity into 2 parts - anterior and posterior. Fractures of the roof and floor of the orbit, which lie anterior to this plane, lead to a vertical change in the position of the eyeball. Fractures lying posterior to this plane lead to changes in the position of the eyeball in the anteroposterior direction. Therefore, it is very important to localize the position of the fracture in relation to the eyeball using CT.

The thick bony edges of the orbit are a fairly durable formation. The middle part of the orbit is thin and often breaks without breaking the edge, absorbing the force of the impact. In the posterior third of the orbit, the bones are thickened and therefore fractures of this part of the orbit are rare, due to the dislocation of the anterior and middle orbital segments, which occurs during traumatic exposure.

Fractures of the orbital walls can be isolated, but usually they are combined with other fractures of the facial skeleton (fractures of the zygomatic bone, nasal bones, ethmoid bone, Le Fort II and Le Fort III fractures of the upper jaw). Isolated fractures may involve only part of the inner bony surface of the orbit. For example, this happens with an explosive fracture of the orbital floor, the so-called blow-out fracture. Usually there are fractures of several parts of the orbit, when its edge and one or more walls are simultaneously damaged. Most orbital fractures therefore require stabilization of both the margin and the interior.

Classification and diagnosis of orbital fractures

The classification of orbital fractures is most often based on anatomical principles. However, for clinical practice it is important to evaluate not only the location of the damage, but also the degree of damage to the integrity of bone formations, which is determined primarily by the degree of energy impact on them.

According to the integrity of the skin:

open (i.e. having a contract with the external environment, including the paranasal sinuses);
closed (isolated from the external environment).

By severity of damage:

with displacement of bone fragments;
without displacement of bone fragments;
incomplete (cracks).

At the point of impact:

straight (fracture at the point of application of force);
indirect (the fracture is distant from the point of application of force, occurs due to general deformation).

Numerous types of orbital fractures can occur alone or in various combinations with other facial injuries. The most common types of orbital fractures are:

“burst” and depressed fractures of the lower wall of the orbit;
“burst” and depressed fractures of the medial wall of the orbit;
nasoorbitoethmoidal (NOE) fractures;
fractures of the zygomatic-orbital complex;
fractures of the upper jaw according to Le Fort type II and III;
frontobasal fractures (including damage to the walls of the frontal sinus, “explosive” and depressed roof fractures; fractures of the apex of the orbit, including those involving the optic canal; local fractures caused by sharp objects pierced into the orbit; as well as supraorbital, glabellar, isolated fractures of the supraorbital edge ).

In addition, when assessing each fracture, it is advisable to distinguish three types: low-, medium- and high-energy.

A low-energy fracture —incomplete (greenstick type) or with minimal displacement of fragments—as a rule, does not require surgical treatment.
A medium-energy fracture is characterized by a clinic typical for this nosological form, moderate displacement of fragments; involves open reduction and rigid fixation of bone fragments using typical approaches. This is the largest group of patients requiring standard treatment algorithms (a-d - medium-energy fracture of the lower edge and lower wall of the orbit).
Finally, the high-energy variety is a rarely occurring small-comminuted fracture with extreme degrees of displacement and severe instability of fragments, a violation of the architectonics of the face (e - high-energy fracture of three walls of the orbit, f - extreme degree of high-energy fracture, usually a component of a panfacial injury. Finely fragmented fracture of all walls of the orbit is not uncommon combined with destruction of the eyeball).

For complete visualization and reposition of damaged bone structures, multiple approaches are required, and the severity of the injury requires individual surgical tactics in each specific case.

Diagnostics

Diagnosis of orbital fractures is based on examination and X-ray examination of the patient.

Fractures of the lower and inner walls of the orbit are often classified as ENT pathologies.

The examination of a patient with orbital injury should begin with a complete examination of the head and face, including examination of cranial nerve function. Depending on the severity of combined TBI, the question of the nature of intracranial damage should be clarified.

An ophthalmological examination is necessary to detect severe injuries such as rupture of the eyeball, damage to the optic nerve, or increased pressure in the orbital cavity.

Hyphema, retinal detachment, rupture of the eyeball, damage to the optic eye, according to the literature, are observed in 15%-18% of all cases of orbital injuries, and with fractures of the upper edge of the orbit, which account for only 10% of all periorbital fractures, serious eye injuries occur in 30% cases. The presence of a rupture of the eyeball affects the treatment tactics of the fracture - manipulations associated with pressure on the eyeball are limited; ophthalmological intervention takes priority over bone reconstruction.

Visual acuity and pupillary responses to light are documented before and after on-orbit surgery.

Clinical picture

On external examination, most cases of orbital fractures show periorbital edema, ecchymosis, and subconjunctival hemorrhages.

Fractures of the anterior third of the orbit are characterized by palpable deformity, bony “stepping” and sensory nerve disturbances, the middle third are characterized by changes in the position of the eyeball, oculomotor disturbances and diplopia, and the posterior third of the orbit are characterized by visual and oculomotor disturbances.

The inability to move the eyeball in one direction or another of gaze indicates either paralysis of the oculomotor nerves, or local damage to the external muscles of the eye, which is caused by a bruise or pinched muscles in the area of the fracture.

The clinical picture and further prognosis in most cases depend on the force of the impact and damage to neighboring structures. For example, a fracture of the superior wall of the orbit is often associated with brain damage. Fractures of the lower and inner walls are complicated by the possibility of infected mucous discharge from the paranasal sinuses entering the orbit.

Main signs of fractures:

Bleeding from the nose, bleeding under the skin of the eyelids.
The presence of air under the skin in the eye area (especially common when sneezing or sniffing after an injury). At the same time, when you press on the skin, barely noticeable clicks are felt under your fingers - the bursting of air bubbles in the tissues.
Restricted eye mobility, double vision.
Inability to open mouth wide.
Displacement of the eyeball deeper into the orbit (enophthalmos), downward (hypophthalmos), and rarely - protrusion of the eye outward (exophthalmos).
Decreased skin sensitivity in the cheekbone, cheek, upper lip, lower eyelid, upper eyelid, forehead (on the side of the injury).

Diagnostics

CT is the optimal x-ray examination for diagnosing orbital fractures. Axial sections with a tomograph step of 2-3 mm reveal disorders in the medial and lateral walls and fractures of the nasoethmoid region. Coronal (frontal) sections, obtained directly or reformed from axial sections, reveal fractures of the floor and roof of the orbit and interorbital space.

In the absence of CT, radiographs of the orbits and paranasal sinuses often make it possible to diagnose a fracture of the orbital floor, as well as visualize blood in the maxillary sinus, as well as depression in the area of the orbital floor and hernial protrusion of its contents. A rupture of the medial wall and separation of the frontozygomatic suture may also be detected. In cases where damage to the optic canal is suspected, thinner sections of 1-1.5 mm through the orbital apex and optic canal are necessary, which guarantees a more thorough diagnosis.

In some patients with complex orbital deformity, an axial CT scan on a spiral computer, followed by three-dimensional image reconstruction, is necessary to obtain more complete information necessary for surgical planning. The results of such an examination can be used for laser stereolithography, a technology that makes it possible to obtain a plastic copy of the patient’s skull with a high degree of accuracy. The presence of such a model also allows you to optimize the surgical plan.

The value of MRI examination for orbital injuries lies in the ability to detect soft tissue damage (changes in diameter, ruptures of the extraocular muscles, etc.), as well as retrobulbar and subperiosteal hemorrhages.

Causes of damage

Fractures always occur as a result of physical impact; violation of the integrity of the orbit is no exception:

According to statistics, the majority of such injuries occur among the male part of the population, since representatives of the stronger sex receive similar injuries as a result of fights if the blow falls in the area of the eye or bridge of the nose.
Another common source of orbital fractures is car accidents, where the impact is often on the face.
Injuries while playing sports.
Accidents, falls and impacts with blunt, hard objects.

Symptoms

One of the first signs of an orbital fracture is sharp pain in the eye and the area around it. But, since such a symptom is possible with any disease of the visual system, it is necessary to take into account a combination of factors.

The victim’s vision loses clarity, he sees images “as if in a fog.”
Swelling of the eye and nearby tissues.
Accumulation of blood and, as a result, a blue tint to the skin of the face and eyelids.
Due to hematomas and swelling, the patient cannot fully open his eyes, and it also becomes difficult to close his eyelids.
Loss of eyeball mobility.
On palpation, crepitus is observed at the suspected fracture site.
Double vision often occurs with this type of injury.
Displacement of the eyeball - it can move to the side from its axis or forward, or go deeper into the orbit.
Hyperemia of the eye.
In some cases of orbital fractures, bleeding occurs.
Strabismus - the victim's eyes do not look at one point.
Drooping of the upper eyelid.

Statistics and features of orbital fracture

Most often, people receive such injuries in the first 30 years of life. The main patients with orbital fractures are men from 20 to 40 years old. Slightly less than half of the cases (40%) of eye orbital fractures are combined with neurological problems. Patients will require consultation and assistance from a neurosurgeon.

Statistics indicate that about 60% of fractures are so-called “explosion” fractures of the bones of the lower wall of the orbit of the eye.

The complexity and danger of such damage to the bones of the skull lies in the fact that it is often not isolated: the bones of the orbit are broken along with the frontal, temporal and zygomatic bones, as well as the bones of the nose. They are well connected and break easily under strong pressure or impact. Moreover, it is not necessary to get hit directly in the eye to break the eye socket itself. It is enough to damage nearby bones.

Fractures of the orbital bones alone account for 16%, the remaining 84% of such injuries are fractures of the orbital bones and adjacent bones.

Diagnostics

The above first signs of an orbital fracture will help establish a diagnosis in simple cases or give a preliminary assessment in severe, complicated injuries. The traumatologist, after a personal examination, may prescribe a number of procedures to confirm the verdict.

X-ray method that combines simplicity and reliability. The image will show the condition of the damaged orbit, as well as possible associated injuries.
Computed tomography will determine the slightest changes in the bone tissue of the orbits. An additional advantage of CT is the ability to determine damage to nearby organs, as well as blood vessels and nerves.
MRI is an equally effective procedure that allows you to assess the condition of the orbit and eyeball, as well as identify the affected area.

Classification of orbital fractures according to various characteristics

Each medical case is individual, therefore a classification of orbital injuries has been introduced.

According to the nature of damage to the integrity of the skin:

Closed - such a fracture of the orbit is called isolated, since it does not contact adjacent organs and the external environment.
Open - the skin and internal membranes of the orbit are damaged, there is a high risk of infection and spread.

According to the location of the damage:

Direct impact - the blow fell directly on the orbital area of the eye.
Indirect impact - the walls of the orbit were damaged as a result of pressure and displacement of other cranial bones, which were deformed in the first place.

Orbital fractures are also classified according to severity:

An injury without a fracture, in other words, a bone fracture. It does not require surgical intervention and is treated with conservative methods.
Fracture without displacement.
Damage with bone displacement. Only an experienced doctor will be able to put the bone fragment in place. Relying on self-medication can lead to tragic consequences.

The degree of intensity of exposure affects how the course of the disease will proceed:

Low-intensity injuries occur when little force is used, often the supposed fracture turns out to be only a crack. With this type of injury, surgery is avoided.
A moderate-intensity fracture occurs with moderate application of force and is characterized by slight displacement of the bones and the presence of a certain number of fragments. To treat these injuries, minor surgery may be necessary to realign the bones, after which rigid fixation of the affected area is required.
Injuries with a high-intensity level of impact are characterized by a large number of wandering fragments that are unstable, multiple ruptures of the skin, associated injuries, as well as disturbances in the structure of the face. This type of damage occurs when more than 2 orbital walls are broken.

The situation can only be corrected with the help of a surgeon and other specialists; you should contact them as quickly as possible.

Main symptoms of an orbital fracture

An orbital fracture is accompanied by a number of characteristic symptoms. First of all, this is severe swelling around the eye and hemorrhage. In addition, symptoms of injury include:

The swelling spreads to the nose and upper cheeks, the eyelids, as well as the teeth and gums of the upper jaw are affected.
Decreased sensitivity of different parts of the face.
Difficulty moving the eyeballs.
Visual impairment, which is manifested by doubling of objects. This occurs due to internal hemorrhage between the soft tissues and the periosteum.
Enophthalmos often occurs, in which case the eyeball seems to fall inward.
Crepitation sounds occur due to the development of subcutaneous emphysema.

In addition to these symptoms, there may be a disturbance in facial configuration. Sometimes strong asymmetry is visible.

A fracture of the upper wall of the orbit is considered less traumatic than the lower one. This is due to the fact that there is no risk of damage to the nasal bones and mucus getting into the pathological focus.

First aid

If the victim experiences pain around the eye, as well as swelling and bluishness of the tissues of the eyelids, it is necessary to call an ambulance. While she is driving, anyone can take a number of measures.

If you have the necessary medications, it is recommended to wash the wound with an antiseptic and instill drops aimed at combating the infection that could possibly penetrate into the lesion.

To reduce pain and swelling of the eye, a cold compress is applied to the damaged area.

To alleviate the condition of the victim, he can be given painkillers.

Even if there is a visible presence of foreign bodies in the eyeball, a non-specialist should not try to remove them. The best option in this situation would be to apply a loose sterile bandage made of any clean material, so that it completely covers the affected area.

Possible consequences of a damaged eye socket

Violation of the integrity of the orbit is considered a serious injury that requires timely provision of qualified medical care. If care or treatment is not provided promptly, there is an increased risk of the onset and progression of numerous serious complications and health problems.

In the majority of clinical cases, the consequences of a fracture of the orbital bones are associated with impaired visual functions, which can affect not only a sharp deterioration in vision, but also provoke an irreversible loss of visual function.

The most common complications after an orbital fracture are the following pathologies:

strabismus;
diplopia;
purulent-inflammatory processes of an acute nature.

Often this injury is accompanied by problems such as concussion and painful shock. Due to the fact that mucous nasal secretions can get into the orbital area, there is an increased risk of developing various diseases of infectious origin.

The severity of complications due to untimely or improper treatment of an orbital fracture

If appropriate treatment is not provided if the integrity of the healthy structure of the orbit is violated, within a few months the patient may develop fibrous bone adhesions. In this case, we are talking about the complete destruction of bone fragments of the wall of the orbit, instead of which scar structures appear that are unable to perform the functions of bone tissue in the human body. This can lead to irreversible pathological processes.

Modern medicine can prevent various consequences of a broken eye socket and even help restore the patient’s visual function. In addition, it should be borne in mind that the above fracture can cause impaired blood circulation, since such injuries are accompanied by significant damage to the blood vessels.

Since an orbital fracture is accompanied by muscle damage, a person has problems with normal movement of the eyeballs and its position does not change. The severity and hematoma of a fracture have a significant impact on the formation of scars, due to which the face is distorted and vision deteriorates (various pathological conditions of the iris).

The main reasons for the development of consequences of a broken eye socket

It is precisely because of the increased risk of various complications of an orbital fracture that it is especially important to know how to properly provide first aid. If the victim has a serious condition, that is, there is a nosebleed due to damaged blood vessels, it is imperative to try to stop it.

For this purpose, it is strictly forbidden to throw your head back, since in such cases it is recommended to use tampons, cotton or bandage “turundas”. In addition, using something cold is considered effective, which helps reduce the size of swelling under the eye. Washing is permitted only with the use of a disinfectant solution.

Treatment

Treatment for orbital injuries depends on the severity of the fracture. For a successful recovery, the patient will need to be observed not only by a surgeon, but also by an ophthalmologist and an ENT specialist.

The goal of all medical procedures is to restore the integrity of bone tissue and return displaced fragments to their places. Treatment should correct existing vision problems, such as squinting and double vision.

For simple fractures and cracks, it is possible to do without surgery using medication and fixation of the fracture. In this case, the patient must remain completely calm and should not sneeze or blow his nose.

If the fractures are complex, displaced, and there is also a risk of vision loss and the spread of pathogenic microflora from the nasomaxillary sinuses, the victim must be operated on immediately.

Additionally, it may be necessary to correct the incorrect position of the eyeball.

If eye pressure is high, surgeons delay surgery. This choice of doctors is fraught with risks, if hemorrhage occurs, the pressure in the eye will reach a critical level. You will need to use a drainage device.

In the absence of treatment, within 2-3 weeks after the accident, the bones begin to heal incorrectly, and the wandering fragments of the lower wall are destroyed. Instead, scar tissue forms.

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Accelerated diagnostics using modern tomographs.
A wide range of methods for surgical reconstruction of damaged bone tissue of the orbit, including using minimally invasive access, natural and artificial implants.
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Rehabilitation

For a speedy recovery and return to the pre-traumatic state, the patient will need to undergo a rehabilitation course. After the operation, it takes from 2 weeks to a couple of months.

Rehabilitation therapy includes:

taking medications that provide pain relief, suppression of inflammatory processes, and also increase the patient’s immunity.
Additionally, the attending physician may prescribe physical therapy.
Taking medications containing essential vitamins and minerals for more intensive bone tissue restoration.

It is extremely important to follow all doctor’s recommendations and prescriptions.

Consequences

Even with timely treatment, it is impossible to restore the vision that the patient had before the accident.

When a victim delays going to the hospital, he may develop a number of the most unpleasant consequences of an orbital fracture:

The lack of medical intervention, including putting the displaced bone in place, will lead to improper fusion of bones and the formation of scar tissue in places where they are missing. This structure cannot cope with the functions of the bone frame.
It is likely that an infection may get into the wound, causing further decay and an abscess.
When the orbital bone is injured, the eye muscles often tear, after which the mobility of the eyeball is impaired, and the victim cannot change the direction of gaze. To look at an object on the side, a person has to turn his whole body.
A pinched muscle leads to strabismus.
Violation of facial symmetry, scars and cicatrices.

Unfortunately, it is completely impossible to avoid the negative consequences of eye socket injuries, but it is within the power and in the interests of every person to reduce the likelihood of their occurrence. To do this, you need to go to the hospital for help as soon as possible. If the displaced bones are not put in place within a couple of months, they will grow together in a deformed form, which will affect the person’s appearance. In addition, the full functioning of the visual organ will be forever impaired.

Therapy

Orbital fractures require complex treatment. In each case, the treatment regimen is determined individually, taking into account the condition and age of the patient. Can be assigned:

Broad-spectrum antibiotics to prevent infection.
Symptomatic treatment to eliminate pain, bruises and swelling.
Surgical treatment is necessary to restore the symmetry of the skull, as well as eliminate intraocular hematomas.

Injuries of this nature differ markedly in the location of the damage and their severity. At the first examination of the patient, the doctor cannot always determine whether surgical intervention is necessary or not.

Indications for surgery

There are a number of indications for the operation. The need for surgical intervention in a particular case is determined by the doctor. The main indications are:

Visual impairment. Often, due to a fracture of the orbit, the visual organ is slightly displaced, which leads to double vision. A significant hematoma can lead to severe compression of the optic nerve and loss of vision. Bone fragments can block muscle contraction, which will ultimately lead to impaired eye movements.
Severe disturbance of facial features. Surgery is necessary if the eye has moved lower and there is asymmetry of facial features.
If the infraorbital nerve is compressed by a bone fragment and this causes numbness in the cheeks, lips or nose.

In addition, surgery is also necessary if the injury causes severe bleeding or the face is severely damaged.

It is advisable to perform surgery immediately after the fracture, before swelling develops. If swelling has already appeared, it is recommended to wait a few days.

Operations are divided into early ones, which are performed in the acute period, within two weeks after injury. At this time, the most optimal conditions for restoring the integrity of the damaged organ.

But the operation can also be delayed. In this case, surgery is performed two weeks after the injury, but no later than four months after the injury. Doctors call this period the gray period.

Finally, the operation may be late, several months after the injury. In this case, an osteotomy is required and the risk of complications is quite high.

The most effective treatment method is surgery. In this case, several methods are used to correct the bone tissue of the orbits and zygomatic arch. All operations are performed through small incisions, which then heal and leave no scars. This operation can be performed from one of the walls of the orbit. During the surgical intervention, extensive access to the fracture site is provided, and it is also possible to implant different types of prostheses.

If there is a foreign body in the orbit and its removal will not damage the eye, then surgery is prescribed.

Postoperative period

During the first few days after surgery, patients complain of pain. Swelling and subcutaneous bleeding appear in the operated area. Eye movements remain limited for several days, and objects may appear in two. All these symptoms disappear without a trace within a few days, but sometimes it takes a couple of weeks for complete restoration of visual functions. Sensitivity may be impaired for several months, but then everything is restored.

It is worth considering that there are contraindications for surgery to restore the bones of the orbit. This includes severe traumatic brain injury and pathologies for which any operations are strictly prohibited.