“Blow out fracture” is a specific term for a fracture of the orbital wall located under the eye. It is the most common type of orbital wall fracture that occurs after facial trauma. The lower orbital wall is a very thin bony structure, and it anatomically forms the upper wall of the air-filled cavity in our face known as the maxillary sinus. Therefore, this wall is quite sensitive to trauma. The characteristic feature of a blowout fracture is that when a bone fracture occurs, the eye and surrounding tissues within the eye socket fall into the underlying sinus air space.
Why does a blowout fracture occur?
Blowout fractures are caused by blunt traumas, such as a punch to the eye or similar incidents, which increase pressure within the eye socket. This pressure pushes down on the thin and unsupported bone underneath, leading to a fracture.
Who is at risk of blowout fractures?
Blowout fractures can occur in the following individuals:
- Boxers (from hard punches to the face)
- Soccer players (from hard balls hitting the face or elbow strikes)
- Motor vehicle accidents, both inside and outside the vehicle
- Motorcycle accidents
- Home accidents (e.g., hitting a door)
- Tennis players (from the ball hitting the eye)
Blowout fractures can lead to the following symptoms:
- Double vision
- Limited eye movement
- Severe bruising around the eye
- Internal bleeding in the eye
- Initially, the eye may protrude forward and gradually recede backward
- Eyelid drooping
- Numbness or loss of sensation in the cheek area
- Sensation of air bubbles when pressure is applied around the eye (Crepitus)
- Asymmetry
How is the diagnosis of a blowout fracture made?
After trauma, a comprehensive eye examination should be performed, including an evaluation of the bones around the eye. Suspicion of a fracture should arise if double vision, limited eye movement, or crepitus is present. Axial and coronal orbital computed tomography (CT) scans are often used to confirm the diagnosis of the fracture. CT scans are a valuable imaging tool both in the diagnostic phase and during surgery if the fracture requires intervention.
How is a blowout fracture treated?
The primary concern is whether the fracture requires surgery, which your doctor will determine based on the examination and CT scan results. Initially, treatment involves cold compresses, anti-inflammatory medications, and antibiotic therapy. Surgery should be planned once significant swelling and bruising have subsided.
When should blowout fracture surgery be performed?
The timing of surgery is crucial. If there is entrapment of muscles and nerves within the fractured area, surgery is urgent and should be performed as soon as possible. If there is no muscle entrapment, surgery can be delayed until bruising and swelling have resolved, typically within 1-2 weeks after the injury.
Is surgery necessary? Will the bones not heal without surgery?
The bones will heal, but the issue is with the alignment of the bones. If your doctor recommends surgery, it should be done within three weeks at the latest. Delaying surgery beyond this point can make it significantly more challenging to correct the bone alignment. What happens if you don’t have surgery after a blowout fracture? Firstly, if you have double vision, it may become permanent, and even if surgery is performed later, the double vision may not improve. Secondly, the structures within the eye socket, as a result of the widened socket due to the fracture, may lead to shrinkage and asymmetry in that eye.
How is the surgery for a blowout fracture performed?
The surgery is typically performed under general anesthesia, and you may need to stay in the hospital for one night. During the surgery, we reposition the displaced eye and the surrounding tissues back to their original positions. Any fragmented bone tissue is removed, and a compatible material (such as bone or Medpor) is placed in the fracture site as a barrier.
Is the surgery performed as an open or closed?
Both open and closed approaches can be used for the surgery. However, a closed approach is usually preferred due to the reduced risk of postoperative complications and better aesthetic outcomes.