Eye Socket Fractures and Other Orbital Bone Disorders

The eye socket can be the site of any number of injuries and conditions. The job of the socket, otherwise known as the orbit, is to keep the eye protected. However, the eye socket can be vulnerable to conditions such as fractures, infections, and more.

Eye Socket Anatomy

Usually, the eye is safely cocooned in the proper position, sitting in the bony orbit. Attaching the eye here are six muscles that allow tandem movement in many directions within the socket. These attach to the sclera, the tough outer white surface of the eye.

Protecting the eye are the seven bones of the orbit. These include:

• Ethmoid
• Frontal
• Lacrimal
• Maxilla
• Sphenoid
• Palatine
• Zygomatic

Through the orbit, the eye is not only connected to needed veins and arteries but also to the all-important optic nerve.

Orbital Fractures

While the socket is generally resilient, if you accidentally get hit in the eye during a sporting event, are involved in a car accident, or have a physical altercation, there is the potential for an orbital fracture.

Also, not all of the bones are the same. The socket rim is thick and made to be resilient. However, the bones on the sides and the floor of the socket are actually quite thin in places. Fractures can take place in any or all of these areas.

Types

The specific type of orbital fracture relates to which bones have been affected. Here are the possibilities.

Orbital Rim Fracture

Usually, these occur during a car accident, if your face collides with the steering wheel or dashboard during impact. In such accidents, which usually involve considerable force, there often may be other injuries to the surrounding areas of the face and even the optic nerve.

Such orbital rim injuries fall into two different categories:

• Zygomatic fractures: These involve the lower orbital rim.
• Frontal bone fracture: Otherwise known as frontal sinus fractures, these pertain to the upper eye rim.

The eye muscles, sinuses, tear ducts, and even the nerves that bring sensation to the forehead and cheek area may also be involved.

Direct Orbital Floor Fracture

With one of these fractures, impact to the orbital rim not only causes it to crack but also extends to the socket floor.

Indirect Orbital Floor Fracture

This kind of break is also dubbed a "blowout fracture." While the rim itself doesn't crack, the very thin floor of the socket does. This usually happens when the eye is hit by something larger such as a baseball or even someone's fist.

With this, a hole can be created in the bony floor of the socket, entrapping eye muscles. The result can be double vision and difficulty moving the eyes normally.

Trapdoor Fracture

A trapdoor fracture is a particular form of blowout fracture. It occurs when the trauma creates a hinged bone fragment. This can swing open to allow a muscle or other tissue through but then swings closed, entrapping it.

The trapped tissue may lose its blood supply and also restrict the eye from moving freely. Children are particularly vulnerable due to their bones' elasticity.

Cavernous Sinus Thrombosis

Infection around the socket could be another concern. Behind each socket are hollow areas known as the cavernous sinuses. These are just beneath the brain. Through this area, blood flows away from the brain via the jugular vein.

However, if this area becomes infected, a clot can develop and keep the brain from getting sufficient blood drainage. The result can be damage to the brain and eyes, as well as area nerves.

Indications of this condition include:

• Bulging or swelling around the eyes
• Sharp headache pain, usually in the eye area
• Severe eye pain
• Double vision

Even if you have some of these symptoms, it's unlikely to be caused by cavernous sinus thrombosis. Still, to rule this out, be sure to bring any ongoing headache or unusual eye-bulging or swelling to your doctor's immediate attention.

Inflammatory Orbital Pseudotumor

This type of inflammatory reaction of the orbital tissues can mimic a brain tumor compressing area tissues. However, this is not cancerous and does not spread elsewhere in the body.

Some symptoms of this condition include red swollen eyes, double vision, eye pain, and restricted eye motion.

In more mild cases, this may go away on its own. Sometimes, however, steroid therapy may be needed. In the most severe cases, surgery to move orbit bones may be needed to reduce pressure.

Infections

Common area infections such as colds, styes, or sinusitis, as well as injuries, all have the potential to lead to cellulitis, involving soft tissue inflammation. There are actually two different forms of cellulitis—orbital and preseptal.

Preseptal Cellulitis

This is a bacterial infection involving the tissues in front of the orbital septum, not within the orbit itself. Most cases are usually minor. The exception is when young children are involved.

Symptoms here can include sudden tenderness, redness, or swelling of the lids, accompanied by fever, irritability in young patients. and general malaise. It is treated by oral or intravenous antibiotics.

Orbital Cellulitis

With orbital cellulitis, the infection is within the socket itself. With this condition, you may notice sudden swelling of the lids or the white part of the eye, pain with eye movement, double vision, blurred vision, fever, and severe malaise.

Hospital admission is usually required, with treatment by intravenous antibiotics. Surgical drainage may be needed.

Tumors

In some cases, orbital tumors can occur. These can be benign or cancerous. Because the orbit space is tight, even a small tumor may cause problems. With bigger tumors, the eye may actually bulge forward, and more severe vision issues may arise.

Besides bulging eyes, tumors may cause pain, lid drooping, double vision, and even vision loss.

If a tumor is noncancerous, these can be treated with drugs or removed using laser or surgery. However, if they are cancerous, in addition to removal, radiation, chemotherapy, or some combination may also be needed.

Graves' Disease

This condition can sometimes mimic a tumor, affecting the fat and muscle tissues of the eye, causing these to swell. With Graves' disease, these swollen tissues may push the eye forward. The eyelids may also retract. This may cause a bulging eye appearance.

With this autoimmune condition, the body attacks its own thyroid gland by mistake. This sends the gland into overdrive, causing it to produce too much thyroid hormone. Initially, treatment centers on lowering thyroid levels with drugs, radiation, or surgical removal.

In addition to eye bulging and lid retraction, patients may experience double vision, vision loss, and dry eyes. This happens during the first stage of the disease.

The stable second stage is when any needed cosmetic correction occurs. Some may need to undergo orbital decompression surgery. In mild cases, this may mean just removing some fatty soft tissue.

For more moderate cases, it may be necessary to sculpt away bone from the sides and floor of the orbit. This makes room for any enlarged tissues resulting from the disease, decreasing eye bulging and pain.