Will insurance pay for me to have my orbital blowout fracture fixed if my vision is still ok?

Thank you for sharing your questioning concerns.  It is quite possible that over the past 3 years since your trauma that the eye may have "sunken" a bit.  At this point, I would recommend consulting with a board–certified oculoplastic surgeon or ophthalmologist to discuss your options.  A thorough physical examination, which would include an ophthalmological examination, visual fields, retinal exam, among other tests, would be indicated prior to making any assessments about whether surgery would or would not be indicated. Good luck and thanks afain for sharing!

When you have a fracture of the bony orbit, it can change the position of the orbital contents once the swelling goes down. This can change the position of your eye. Most commercial insurances cover repair of orbital fractures. This can easily be checked by doing a predetermination before any surgery.

After a blow out fracture the orbital contents (eye ball and fat) can sink into the cone of bone which makes up the orbit.  This can be due to an enlarged cone (because of the fracture) or fat loss around the eye ball). The structures retract and pull the eye ball in.  This is called enopthalmus and is extremely difficult to correct surgically as you must release and put traction on the shrunken tissues, including the optic nerve, before correcting the defect.  Very few, highly trained craniofacial surgeons are qualified to even discuss this issue with you.  Be very careful about who you see for this significant problem.

Who knows about insurance anymore, I guess they SHOULD pay for it. What makes you think it is a medial (ethmoid) fracture? If you have significant enopthalmus( greater than 5mm of ocular displacement) and the globe must be released and brought up and forward, gaining symmetry can be an extremely difficult endeavor. There are highly reputable craniofacial surgeons who opine that fixing a chronic enopthalmus is impossible. This sounds more difficult than stuffing some plastic into your orbit so I would see a plastic surgeon with craniofacial experience. If it is not fully corrected with some kind of implant done by a oculoplastic surgeon, it then will be truly a nightmare to fix.

Thank you for your question. Your insurance company should cover a fracture after a trauma. You should consult with a oculoplastic/plastic surgeon who is comfortable with orbital trauma in your area. They will be able to submit the appropriate codes to the insurance company for a pre-authorization to determine coverage. The surgery will involve an incision on the inside of your eyelid and placement of an implant along the orbital floor to support the eye. Goo luck.

After 3 years this might not be worth undergoing surgical reconstruction.  If you have a visibly sunken eyeball, then it is possible insurance would cover the procedure.  The bone that is involved is actually the ethmoid sinus.  There are 2 major arteries that penetrate that area.  I think your original surgeon was wise to recommend not operating unless you had entrapment of your eye motion.  Seek the opinion of a Facial Plastic Surgeon who has experience with this type of procedure.  It is not a common operation, as the majority of surgery for blow out fractures involves the inferior wall or floor.  There will be significant risks involved.

Fractures of the orbit can lead to enlargement or expansion of the orbital bony cavity. This can lead to enophthalmos or "sunken eye". A comprehensive orbital exam by an oculoplastic surgeon can determine the amount of enophthalmos to the millimeter. This can certainly be covered by insurance. Risks include pain, bleeding, infection, double vision, and need for further surgery. The key is to find a surgeon that is experienced with orbital trauma and repair of orbital fractures. There are many oculoplastic surgeons in your area. Vikram D. Durairaj, MD FACSAustin, Tx

If you have a visible deformity of a sunken eye most probably insurance will cover the surgery, but you will have to go through the physical exam and evaluation of a facial Plastic Surgeon or Oculoplastic Surgeon. Also the insurance can tell you ahead of time if they will cover the procedure.Hope this helps,Dr. Gus Diaz

The only time insurance would pay for a blowout fracture repair would be if you have enophthalmos or the eye is sunked. Talk to an oculoplastic surgeon.

Thanks for your question. Insurance should always cover repair of traumatic injuries even though it has been a couple of years. In a medial orbital blow out fracture, the ethmoid bone is fractured. This bone is extremely thin and we will sometimes do this on purpose for people with protruding eyes. Usually a medial blowout fracture doesn't change how you look, but it may lead to double vision if one of the muscles that moves your eye gets involved in the fracture. They are fairly easy to repair, but I'd visit with either an oculoplastic surgeon or a facial plastic surgeon who is experienced in facial trauma. If possible, you should bring a CD with your CT scan to your visit so the surgeon can review it. Good luck.