Orbital Fracture - Will It Fill in on Its Own?

Question

From the report:  Left orbital floor blowout fracture with minimal displacement identified. Minimal intraorbital fat extends into fracture defect. No extra muscle entrapment identified by CT.  The orbits appear normal. Specifically, the globes, optic nerves and extracular muscles appear normal. Minimal anterinferior left orbital emphysema is present  No air-fluid levels identified within the paranasal sinuses. Bilateral inferior maxillary sinus retention cyst or polyps noted.   I was hit in the left eye/nose area. Doc said I have a fracture (went in 1mm) that will fill in on it's own. Will it? Also, will it get strong?

Stephen Prendiville, MD · Answer

As other posters have noted, the presence of a non-displaced orbital fracture does not require surgical intervention. The chief concern in these situations is entrapment of the inferior rectus muscle, which causes limitation in motion on up-gaze, and double vision. However, the greatest long term concern is what is termed enophthalmos, or sinking in of the affected eye. This is caused by atrophy of the orbital fat and/or muscles. The more severe the injury, the more likely this is to occur. However, it can occur even with non-displaced orbital fractures.

Otto Joseph Placik, MD · Answer

With the limited amount of information available here, it appears that non-surgical managment and observation is the treatment of choice in your particular situation. Generally it should heal with an excellent outcome.

Robin T.W. Yuan, MD · Answer

Not all blowout fracture require surgical repair. If you have entrapment, enophthalmos, or change in level of the pupil, then surgery may be indicated. if not, there may be little consequence to a technical blowout without significant change in intra-orbital volume. However, sometimes the changes do not show up until late.

Peter A. Aldea, MD · Answer

The floor of the eye socket is egg shell thin. A blow to the eye (fist, ball etc) which hits the globe will crack the floor resulting in a "blow out" fracture. Commonly, these fractures are also associated with a fracture line that goes from the side wall of the socket, across its floor and inferiorly across the cheek bone. Such fractures are referred to as "trimalar or quadropod or temporozygomaticomaxillary fractures".
We would need to operate whenever the deformity (bones are out of alignment) or function (double vision on looking upward, numbness) are found. When those are not found, the indications for surgery depend on the extent of the floor fracture and the likelihood it would lead to a sunken eyeball.
In your case, most surgeons would observe and allow the fracture to heal without taking on the risks and little benefits of surgery.

Yoash R. Enzer, MD, FACS - Account Suspended · Answer

Your report indicates an orbit fracture, but does not indicate the size of the fracture. The decision of whether or not to repair an orbit fracture depends on the size of the fracture and whether or not there is double vision.  Also, you were struck in the eye, and therefore a careful eye and dilated pupil exam by an ophthalmologist is mandatory to make sure there is no serious damage and threat to your vision.  
If the fracture is small and there is no double vision, it need not be repaired, and you will not suffer any undue consequences.  But as you may surmise, "small" is a relative term, and therefore you might get different recommendations from different physicians.  If not repaired, your eye will sink inward, and look smaller after the swelling resolves.  It is best repaired within a few days of the injury before scarring sets in place.

Orbital Fracture - Will It Fill in on Its Own?

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