Fractures

An injury to the face can fracture any of several bones that form each orbit.

Vision may be impaired when blood that accumulates after a fracture, typically from torn blood vessels, puts pressure on the eye or on the nerves and blood vessels going to and from it (retrobulbar hematoma). Pressure on the nerves may impair vision by interfering with nerve impulses going from the eye to the brain. The fracture (or a bone fragment) may also impair the function of the muscles that move the eye (possibly by damaging the muscles themselves or the nerves that move the muscles). Damage to these muscles may inhibit eye movement up, down, or to the right or left and thereby produce double vision. The eyeball may become sunken (enophthalmos) if the fracture is large. The eyeball itself also may be damaged in these injuries.

Diagnosis and Treatment

Diagnosis is suspected based on the symptoms. X-rays of the skull and computed tomography (CT) or magnetic resonance imaging (MRI) confirm the diagnosis. When a fracture traps muscles or soft tissues of the orbit and produces double vision or makes the eyeball sunken, surgical repair of the facial bones is usually necessary. After ensuring that the fracture has not damaged a vital structure, the surgeon restores the bones to their proper positions, sometimes using small metal plates and screws or wires to hold them in place. The surgeon may use a thin plastic sheet or a bone graft to connect the broken parts and assist healing.