injuries and poisoning
Fractures of the Orbit
Blowout fracture
Sometimes the eye is struck in such a way that the force of the blow is received by the eyeball and not blocked by the strong bones around the eye (as when struck by a small object such as a golf ball or a fist). In this case, the pressure on the eyeball is transmitted to the walls of the orbit. This pressure can fracture one of the most fragile parts of the orbit, the part underneath the eyeball (orbital floor). Direct blows to the face can also transmit forces causing the same fracture. These types of injuries are known as blowout fractures. Sometimes parts within the eye socket, such as a muscle attached to the eye, are forced through the fractured bone and become trapped—this happens most often in teens and young adults and requires urgent repair. Blowout fractures sometimes cause double vision, a sunken eyeball (particularly once the swelling resolves), an eyeball that is lower in the face, a decreased sensitivity to touch and pain around the cheek and upper lip (caused by injury to the nerves below the orbit), or an accumulation of air and/or blood in the tissues under the skin (subcutaneous emphysema and ecchymosis). Double vision can occur because the eye is severely swollen or if one of the muscles that move the eye is trapped in the fracture. The trapped muscle, usually the muscle that moves the eye down (the inferior rectus), prevents the eye from aiming itself at the object the other eye is looking at. Subcutaneous emphysema occurs if a fracture of the orbital floor allows air from the nose or sinuses to enter the tissues around the eye, particularly when people blow their nose. Bleeding can also occur in the eye socket (orbital hemorrhage) or the eyelids. Rarely, an increase in air or blood within the eye socket can lead to very high pressure of the eyeball, which must be addressed urgently. 