Eye Health More Eye Issues & Safety Eye Socket Fractures and Other Orbital Bone Disorders By Maxine Lipner Maxine Lipner Facebook LinkedIn Twitter Maxine Lipner is a long-time health and medical writer with over 30 years of experience covering ophthalmology, oncology, and general health and wellness. Learn about our editorial process Updated on June 11, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by William Truswell, MD Medically reviewed by William Truswell, MD Facebook LinkedIn William Truswell, MD, is a board-certified facial plastic surgeon and otolaryngology (head and neck) surgeon. He is president of the American Board of Facial Plastic and Reconstructive Surgery and treats skin cancer patients as part of his practice. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Anatomy Orbital Fractures Cavernous Sinus Thrombosis Orbital Pseudotumor Infections Tumors Graves’ Disease 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. FG Trade / Getty Images 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 eyesSharp headache pain, usually in the eye areaSevere eye painDouble 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 healthcare provider’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 can include sudden tenderness, redness, or swelling of the lids, accompanied by fever, irritability in young patients. and general malaise. It is treated with 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 including 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 larger 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, it can be treated with drugs or removed using a laser or surgery. However, if 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Academy of Ophthalmology. Parts of the eye and how we see. Harvard Medical School. Eye socket fracture (fracture of the orbit). American Association for Pediatric Ophthalmology and Strabismus. Blowout fracture. National Health Service, U.K. Cavernous sinus thrombosis. University of Pittsburgh Medical Center. What is orbital inflammatory pseudotumor? The College of Optometrists. Cellulitis, preseptual and orbital. American Academy of Ophthalmology. Individual orbital tumors. Weill Cornell Brain and Spine Center. Orbital tumors. National Health Service, U.K. Causes: overactive thyroid (hyperthyroidism). American Thyroid Association. Graves’ disease. Kellogg Eye Center, Michigan Medicine. Thyroid eye disease—what to expect.