Pediatric Eyelid and Orbital Trauma Repair
Types of Pediatric Eye and Socket Injuries
Eyelid injuries range from simple scratches to deep cuts that go all the way through the tissue. Because the eyelid protects the eye and helps spread tears, proper repair is essential. Our ophthalmologists pay close attention to the depth of the cut and its location.
Injuries near the inner corner of the eye, closest to the nose, are particularly complex because they can damage the tear drainage ducts. If these tiny tubes are cut, they must be surgically reconnected to prevent chronic tearing and infection later in life.
The orbit is the bony 'cup' that holds the eye. In children, these bones are more flexible than in adults. When a child gets hit in the eye, often by a ball, a fist, or during a car accident, the pressure can cause the floor or inner wall of the socket to break.
- Orbital Floor Fractures: A break in the bottom of the eye socket. This can cause the eye to look sunken or limit movement.
- Medial Wall Fractures: A break in the bone between the eye and the nose. This often leads to air entering the tissue around the eye, especially if the child blows their nose.
- Trapdoor Fractures: This is a unique injury in children. The flexible bone breaks, pushes open like a trapdoor to let soft tissue or muscle fall through, and then snaps shut. This traps the muscle tightly and is a surgical emergency.
Children are not just small adults. Their bones heal differently, and they may show different symptoms. For example, a child with a serious 'trapdoor' fracture might not have much bruising or swelling (doctors call this a 'white-eyed blowout'). However, they might feel very sick to their stomach or have a slow heart rate because the trapped muscle is pulling on a nerve. Our team in Marlton knows exactly what to look for to catch these subtle but serious signs.
Signs Your Child Needs Immediate Help
Some injuries threaten vision immediately. You should take your child to the nearest emergency room if you see severe bleeding, a change in the shape of the pupil, or if the eye itself looks cut or deflated. If your child cannot move their eye, has severe pain, or is vomiting after an eye injury, these are also emergencies.
If a broken bone traps an eye muscle, the eye cannot move freely. You might notice that one eye does not look up or down when the other one does. Your child might complain of double vision (seeing two of everything). In children, this entrapment can trigger a reflex that causes severe nausea, vomiting, and sleepiness. If your child has a 'black eye' but feels terrible systemically, they need an urgent evaluation.
- DO protect the eye with a rigid shield or the bottom of a paper cup if you suspect a serious injury.
- DO keep your child calm and keep them from eating or drinking in case surgery is needed.
- DO NOT let your child blow their nose. This can force air from the sinuses into the eye socket and cause dangerous swelling.
- DO NOT put pressure on the eye or try to remove an object stuck in the eye.
- DO NOT give ibuprofen or aspirin initially, as these can increase bleeding. Acetaminophen (Tylenol) is safer until a doctor sees them.
Diagnosis and Imaging
We know exams can be scary for kids. Our ophthalmologists take a gentle approach. We check how well the eyes move, test vision, and look for hidden damage to the eyeball itself, such as retinal tears or bleeding inside the eye. We also look for numbness in the cheek or teeth, which can happen if a fracture damages the nerve in the orbital floor.
To see the bones clearly, we typically use a CT scan. This gives us a 3D view of the fractures and shows us exactly where muscles might be trapped. At ReFocus Eye Health Marlton, we prioritize safety and follow low-dose radiation protocols designed specifically for children. We generally avoid MRI for acute trauma to ensure no hidden metal fragments are present, which could be dangerous in a magnetic field.
Treatment Options
Not every fracture needs surgery. If the break is small and the eye moves normally, the bones often heal well on their own. In these cases, we may prescribe antibiotics and decongestants. We will monitor your child closely at our Marlton office to ensure the eye stays healthy as the swelling goes down.
Surgery is necessary if the fracture is large, causes the eye to sink back into the head, or traps a muscle causing double vision. For 'trapdoor' fractures with muscle entrapment, we often operate within 24 to 48 hours to release the muscle and prevent permanent damage. For other fractures, we may wait one to two weeks to let the swelling go down, which makes surgery safer and more precise.
During surgery, our ophthalmologists use delicate techniques to free trapped tissues and, if necessary, place a thin implant to cover the hole in the bone. We use incisions hidden inside the eyelid or mouth whenever possible to avoid visible scars.
Lacerations are usually repaired within 24 hours. We clean the wound thoroughly and use very fine sutures to align the tissue layers perfectly. If the tear duct is involved, we may place a tiny soft tube (stent) in the duct to keep it open while it heals. This tube is easily removed in the office a few weeks later.
Recovery and Aftercare
After surgery or a significant injury, proper home care is vital for a good result. Your child should sleep with their head raised on pillows to reduce swelling. We may ask you to apply cold compresses gently (making sure not to press on the eye) for the first few days.
- No Nose Blowing: This is critical. Your child must not blow their nose for at least two weeks. If they need to sneeze, they should do so with their mouth open.
- Activity Restrictions: No gym, recess, or rough play for several weeks.
- Eye Protection: We may provide a shield for sleeping to prevent your child from rubbing the eye.
We will see your child regularly during the healing process. Our team serves families from across the Greater Philadelphia Metropolitan Area, ensuring you have local access to expert follow-up care. We monitor for infection, check vision, and ensure the eyes are moving together correctly.
Frequently Asked Questions
The eyelid skin heals remarkably well in children. While all cuts leave some mark, we place incisions in natural skin creases whenever possible. Over 6 to 12 months, most scars fade and become very difficult to see. We also provide guidance on scar care, such as sun protection, to help the area blend in.
It is common to have some double vision right after an injury or surgery due to swelling. In most children, this resolves within a few weeks as the inflammation goes down. If double vision persists, we have non-surgical ways to help, such as special glasses, while the nerves and muscles recover.
Every injury is different, but generally, children should avoid contact sports for at least 4 to 6 weeks after an orbital fracture. The bone needs time to become strong again. When they do return to sports, wearing protective polycarbonate sports goggles is essential to prevent a re-injury.
This term refers to a specific type of trapdoor fracture where the eye looks white and uninjured on the outside because there is little bruising. However, the internal damage to the muscle can be severe. It is a deceptive injury that requires an expert eye to diagnose and treat quickly.
Expert Care for Pediatric Eye Trauma
Accidents happen, but expert help is close by. At ReFocus Eye Health Marlton, our ophthalmologists are equipped to handle complex pediatric eyelid and orbital injuries. We work to make the process as stress-free as possible for you and your child, delivering top-tier medical care right here in your community. If you suspect an eye injury, contact us for an urgent evaluation.
Highly recommend this practice. Very knowledgeable staff and were very professional. Dr. Grossman and his staff are good listeners and explain everything clearly.
Laurel Trice
Dr.Glass is the best superb doctor I've seen in years. The entire staff was very friendly and helpful and all around excellent customer service from the entire office. I give the doctor and staff 5 Stars
Bengamite Israel
Today was a great experience at ReFocus. Met with Dr. Heuer. She gave me an excellent eye examination. Very thorough!
Vincent Pestritto
From the moment I reached the front desk to the technician who did my testing of my eyes to Dr. glass who was wonderful and to Katie, his assistant I knew I was in good hands from start to finish
Roslyn Soffer
I came in for an emergency appointment, and they accommodated me and handled my care with compassion and professionalism. Doctors are always prepared, and aware of my medical conditions and concerns.
Cathy Quattrone
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