Orbital Fracture (Enophthalmos, Sunken Eye)

The eye socket, or orbit, is a cup-shaped bony structure that holds and protects the eyeball. It is made up of seven different bones. The rim of the socket is thick and strong, but the floor and inner walls are very thin, similar to an eggshell. These thin areas are designed to crumple under pressure to absorb shock and protect the eye itself from bursting.

When an object strikes the eye, the pressure increases inside the socket. If the pressure becomes too high, the thin bones of the floor or inner wall can crack or shatter. We call this a 'blowout fracture.'

Enophthalmos is the medical term for an eye that sits further back in the socket than normal. This gives the eye a sunken appearance. It happens when an orbital fracture creates a large hole in the floor of the socket. The fat and muscles that usually cushion the eye can drop through this hole and into the sinus cavity below.

Because you lose that volume of support, gravity pulls the eye downward and backward. You might not notice this sunken look immediately because swelling can temporarily push the eye forward. As the swelling goes down over a few weeks, the sunken appearance may become obvious.

Our multispecialty team at ReFocus Eye Health Marlton treats several types of orbital injuries. The specific type of fracture determines the treatment plan.

• Orbital Floor Fracture (Blowout): The most common type, where the bottom of the socket breaks but the rim stays intact.
• Orbital Rim Fracture: A break in the thick outer edge of the socket, often caused by high-impact accidents.
• Trapdoor Fracture: Common in children, this occurs when the bone breaks, snaps back into place, and traps a muscle. This is a medical emergency.
• Direct Orbital Floor Fracture: A break that extends from the rim into the floor of the socket.

Not every orbital fracture requires surgery. If the fracture is small, your eye moves normally, and you do not have severe double vision or a sunken eye, we may recommend observation. During this time, we monitor you closely as the swelling resolves.

To help the bone heal, we will prescribe a plan that avoids any strain on the face.

• Apply ice packs to reduce swelling (do not press on the eye)
• Keep your head elevated, even while sleeping
• Avoid blowing your nose for several weeks
• Take decongestants or antibiotics if prescribed to prevent infection

Surgery is necessary when the fracture threatens your vision, appearance, or eye function. Our goal is to free any trapped muscles and restore the normal shape of the eye socket.

Common reasons we recommend surgery include:

• Muscle Entrapment: If the eye cannot move and causes permanent double vision.
• Large Fractures: If the hole is large enough (usually 50% of the floor) to cause the eye to sink backward significantly.
• Significant Enophthalmos: If the eye has already sunk back by 2 millimeters or more.
• Oculocardiac Reflex: Nausea and heart rate issues caused by trapped muscles (urgent).

During surgery, we typically place a specialized implant over the fracture site. This implant acts as a new floor for the eye to rest on, preventing it from sinking and allowing muscles to move freely.