Broken Orbital Bone and is Sinking, What Should I Do? (photo)

Question

I got punched in the face a lot when I had a drinking problem (sober now) but I'm afraid my eyeball is sinking. I know for sure I broke the orbital floor of my eye at least once (the second time I was in mexico two years and couldn't get a professional opinion). I'd like to know if my eye will keep sinking. Please see the photo and let me know if you think this problem can be fixed. Thank you.

Mehryar (Ray) Taban, MD, FACS · Answer

It appears you have enophthalmos on the left side. This is likely stable, meaning it already sunken that not sinking any more, or maybe worsening if there additional sinus issues. You should consult an oculopalstic surgeon, who with the help of CT scan can better determine possible solutions.

A.J. Amadi, MD · Answer

It is unlikely that things will change this far out from the injury. A CT scan of the orbits [maxillofacial] would help elucidate the problem.

Kenneth D. Steinsapir, MD · Answer

Jimmy

	You left orbit is consistent with a prior orbital facture.  To confirm this you should have a through orbital evaluation by an oculoplastic surgery and a CT scan of the orbits.  This will confirm the degree of change in the orbit and based on this the surgeon will be able to discuss with you a range of options.  You should know that later repairs are often much less successful than immediate repairs.  Does this mean you shouldn't bother with a consultation.  No it does not.  There is an other syndrome that needs to be rules out called the silent sinus syndrome.  The fracture may have sealed the left maxillary sinus.  When this occurs the sinus can slowly collapse over time (the eye would appear to be getting smaller).  The fix for this is sinus surgery to reestablish a drainage path for the sinus and reconstruction of the orbital floor.  Your surgeon will also discuss with you the value of under doing this type of reconstruction and the risks involved.  To find a highly qualified oculoplastic surgeon in your area, look on the website for the American Society for Ophthalmic Plastic and Reconstructive Surgery (asoprs dot org).  They maintain a geographic directory for well qualified oculoplastic surgeons.

Brett S. Kotlus, MD, MS, FACS · Answer

If you had a trauma that caused a fracture of the bones around the eye, it is possible that the eye is sinking backward.  In most cases this can be improved with surgery. The first step is to see a surgeon who has experience with orbital trauma such as an oculoplastic surgeon.  Your doctor will want to get a CT to see what is happening with the bones around the eye.  Surgery can be more difficult when the problem has been there for a while but it is still possible most of the time.  

	Good luck!

Aaron Stone, MD · Answer

Your posted photo shows a smaller left eye than right eye and retrusion or sinking in of the majority of the left middle third of the face. I suspect that there is more going on here than just a fracture of the bone floor under the eyeball as that would not also result in cheek bone retrusion. You need a CT scan in order to assess exactly what is going on before you can undergo any treatment. Unfortunately when these injuries are old the soft tissue around the bones shrinks back and accomodates to the after injury bone architecture. If you wait too long to correct it the soft tissue will not return to its original state after you fix the bone. Therefore although surgery will improve you condition and prevent further deterioration it cannot return you to your before injury look.
	
	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Tito Vasquez, MD, FACS · Answer

Although it is obvious that there is asymmetry between your two eyes, it is difficult to tell whether you have a vertical (up and down) or a posterior (backwards) displacement of your left eye. A proper exam will help determine that. Also a CT scan of your face (specifically ordered to examine your facial bones) will also be important to find out where the volume of your orbit is being displaced. Then techniques aimed to restore the bony orbit, in addition to possibly adding volume via bone grafts or synthetic materials, should be utilized to both provide symmetry and correct any visual disturbances.

Peter A. Aldea, MD · Answer

The eye socket is engineered to rapidly expand in response to injury allowing the eye ball to be easily be pushed in  to avoid damage. This happens with many blows to the cheek or eye regions because the inner wall and floor of the orbit are very thin (egg shell thin) and are essentially a biological crumple zone. They give way to save the eye ball.

	Delayed correction is based on a CT or MRI imaging coming the right and left orbits and which areas need to be filled in. This will require one or more incisions around the eye combined with placement of bone grafts with or without a new artificial floor of the ye socket. 

	Your first step is to be seen by a Plastic surgeon and have a CT or MRI. Be aware that this may not be covered by medical insurance since it s done for cosmetic purposes.

Sam Goldberger, MD · Answer

Actually you have two problems. One is that the eye is already sunken. The other is that the eye will probably continue to sink. You really need to see an Oculoplastic surgeon because even if you would tolerate the way the eye looks now, it is likely to get worse and then you won't tolerate it. Exactly what can be done will depend on a lot of factors. Do you have a CT scan?

Anureet K. Bajaj, MD, FACS · Answer

Jimmy,

	The problem that you are describing is know as enophthalmos.  This refers to the "sinking" appearance of the eye following a fracture of the orbital floor (the bone beneath and around the eyeball).  If your fracture is old, it is unlikely that it will progress further; however, to correct the problem you will probably need to see a craniofacial surgeon (a plastic surgeon who specializes in surgery of the facial skeleton).  He or she  will likely evaluate you with a CT scan and employ techniques to correct the problem which may involve refracting the bone and/or placing something to support the orbital floor.  (You didn't say if you had problems with double vision our to the affected eye....unfortunately, this problem may or may not be able to be corrected, and you may need to see an ophthalmic surgeon for this problem). Good luck!

Chase Lay, MD · Answer

Hello Jimmy,

	This does occur and I can see a little of what's called enophthalmos and hypoglobus in you.  The steps are these:

	1.  Consult with a facial plastics or oculoplastic surgeon.

	2.  Get a CT scan of your orbits.  This will tell your surgeon how much volume loss has occurred in the floor and even give you an opportunity to create a custom implant in some cases.  You options are synthetic implants (great option and the most convenient) or bone from elsewhere.  I don't think you'd need bone.

	3.  The surgery can be done with no external incision called a transconjunctival approach.  The implant is placed through that approach.  You'd have a small incision in the corner of your eye.

	General risks are imperfect result, double vision, or an eye that is pushed up or forward a bit too much.  However, a little too much in the beginning is usually good because that will settle as the swelling goes away.

	Hope that helps.

	Chase Lay, MD

Broken Orbital Bone and is Sinking, What Should I Do? (photo)

Answers (15)

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