Orbital Fractures: Types, Symptoms, and Treatment Pathways
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
A hard hit to the eye can break the bones of the eye socket. Some of these breaks heal on their own, while others trap eye muscles or nerves and need surgery. This guide explains the types of orbital fractures, the warning signs, how they are diagnosed, and the treatment options.
Quick Answer: What is an orbital fracture?
An orbital fracture is a break in one or more of the bones of the eye socket, most often from car accidents or a blow to the face. Symptoms include pain, swelling, a black eye and sometimes double vision. Small fractures may need only ice, while those affecting eye movement may need surgery. Do not blow your nose.
What the research says
Earlier surgery was linked to better recovery of eye movement. A systematic review and meta-analysis of 15 cohort studies (2,666 patients) found that surgery within 14 days was consistently associated with better recovery from double vision and eye movement, especially when a muscle was trapped or the defect was large. Later repair gave acceptable results in selected cases without entrapment (Charmila et al., J Maxillofac Oral Surg, 2026) [2].
Both observation and surgery can work for isolated floor fractures. A systematic review of 27 studies (444 patients; 42 managed without surgery and 381 with surgery) reported that treatment corrected enophthalmos in 85.2%, double vision in 74.8%, restricted eye movement in 61.6%, and sensory problems in 61.1% of the patients concerned. Complication and reoperation rates after surgery were low, and the authors concluded that symptoms, defect size, and surgeon preference should guide the choice (Miran et al., Diagnostics, 2025) [3].
Causes differ by setting, and bruising and bleeding in the eye are common. In a one-year study of 74 people with orbital fractures at a Saudi Arabian trauma center, road traffic accidents caused 64.9% of the fractures, assaults 16.2%, sports injuries 9.5%, and falls 8.1%. Bleeding under the surface of the eye (subconjunctival hemorrhage) was the most common eye finding, at 52.0% (Asiri and Aldowah, Medicina, 2023) [4].
Study details retrieved from PubMed.
What Is an Orbital Fracture?
The orbit is the bony cavity, or eye socket, that holds your eyeball, eye muscles, blood vessels, nerves, and other structures. An orbital fracture happens when one or more of these bones break. Blunt force trauma, such as something hitting your eye very hard, is the most common cause. [1]
Common Types of Orbital Fractures
Type | What it is | Typical cause |
Blowout fracture | A break along the floor or the thin inner wall of the eye socket. It is the most common type. | Getting hit in the eye with something like a fist or a baseball |
Orbital rim fracture | A break in the thick, bony outer edges of the eye socket. It takes a lot of force, and other facial fractures are likely. | Car accidents are the most common cause |
Orbital floor fracture | The bones of the rim push back and the floor bones buckle downward. This can affect the nerves and muscles around the eye and keep it from moving properly. | Car accidents and falls |
What are the symptoms and warning signs of an orbital fracture?
Some people with orbital fractures have no symptoms, but these injuries are usually painful. What you notice depends on the type of fracture and how severe it is. [1]
Symptom category | Common signs |
Vision | Blurred vision, double vision, or decreased vision |
Appearance | Swelling under the eye, a black, blue, or purple bruise around the eye, blood in the white part of the eye, swelling of the cheek or forehead, a flattened cheek |
Sensation | Numbness |
Eye position and movement | Trouble moving your eye in any direction, sunken or bulging eyeballs |
Other | A nosebleed |
What causes orbital fractures, and what complications can occur?
Orbital fractures can happen in adults and children. The most frequent causes in adults are assaults and car accidents. In children, the most common causes are car accidents and being hit in the face with a ball. Bike and motorcycle accidents, falls, and other sports injuries can also cause them. [1]
Possible Complications
Inability to move or feel part of your face, if a nerve or muscle is also injured
Trouble breathing, seeing, hearing, or speaking, depending on where the fracture is
In serious injuries, infections, seizures, bleeding in the brain, and brain damage
In the most severe cases, vision loss or double vision, although most fractures heal without long-term effects
How is an orbital fracture diagnosed?
An eye doctor (ophthalmologist) examines your eye and the area around it. They check whether your eye moves normally and whether you have vision problems, and they may measure your eye to make sure it sits correctly in the socket. They will also ask about your symptoms and request imaging tests such as X-rays and CT (computed tomography) scans. [1]
How is an orbital fracture treated?
Treatment depends on the type and severity of the injury, and it does not always require surgery. [1]
Non-Surgical Care
For a small fracture, an ophthalmologist may recommend: [1]
Ice packs to reduce eye pain and swelling. The eye socket may heal on its own over time.
Keeping your head elevated above heart level to help prevent more swelling.
Medicines. Your ophthalmologist may prescribe antibiotics or decongestants, and pain relievers can help with pain.
No nose blowing. Blowing your nose while your injury heals can cause swelling if the air you blow out collects under the skin around your eye.
Surgery
An orbital fracture is more severe when it stops you from moving your eye correctly or when you also have double vision. In that case, your ophthalmologist may refer you to an oculoplastic surgeon, an ophthalmologist who has special training. The surgeon will decide what type of surgery you need based on your symptoms and how severe the injury is. [1] After surgery you may have bruising and swelling for several days, and your vision may be blurry for a few days. Your surgeon may recommend cold compresses, antibiotics, or anti-inflammatory medicine. [1]
What is recovery and outlook like after an orbital fracture?
The outlook depends on the type and severity of the injury. A simple fracture may heal on its own, and most fractures heal without long-term effects. Recovery from a more severe fracture that needs surgery can take longer. [1]
Return to work or school: After surgery, most people can go back to school or work within a week. You may need to limit strenuous activity, airplane travel, and deep-sea diving for several weeks.
Pain: Some people develop nerve pain that can last for up to nine months.
Double vision and sunken eyes: Some people have persistent double vision, which could need another surgery. Enophthalmos, when the eye sinks in, may worsen with time.
How can people live with an orbital fracture?
Ice packs or cold compresses, a head kept above heart level, and pain relievers can help with pain and swelling. To prevent nosebleeds, your ophthalmologist may recommend a nasal spray that constricts blood vessels for two to three days. [1]
When to Return to Your Healthcare Provider
If you have been treated for an orbital fracture, go back to your provider if you have nausea or vomiting, a headache that will not go away, or a fever. [1]
When to Go to the Emergency Room
Go to your nearest emergency room or call 911 if you develop: [1]
A sudden, severe headache
Seizures
Difficulty walking, talking, or seeing
Numbness or weakness in your body
Blood or fluid leaking from your nose or ear
Fainting
How can orbital fractures be prevented?
You cannot always prevent orbital fractures, but wearing safety gear, such as a helmet or face mask for certain sports, a helmet when you ride a motorcycle or bicycle, and a seat belt in a car, can help. [1]
What is the bottom line on orbital fractures?
An orbital fracture can range from a small break that heals with ice and time to a serious injury that traps eye muscles and needs surgery. Because a black eye can hide a fracture, any hard hit to the eye with double vision, trouble moving the eye, numbness, or severe swelling should be checked by an ophthalmologist. Avoid blowing your nose, keep your head elevated, and get urgent care if you notice emergency warning signs. Prompt evaluation gives you the best chance to protect your vision and heal well.
Frequently Asked Questions
What is a blowout fracture?
A blowout fracture is the most common type of orbital fracture. It is a break along the floor or the thin inner wall of the eye socket, most often caused by being hit in the eye with something like a fist or a baseball.
Can an orbital fracture heal on its own?
Yes, a small, simple fracture may heal on its own over time with ice and rest. Still, see an ophthalmologist to confirm that the fracture is stable and that your vision and eye movement are not affected.
Why shouldn't I blow my nose with an orbital fracture?
Blowing your nose can force air through the break so that it collects under the skin around your eye, which causes swelling. Your ophthalmologist will tell you to avoid blowing your nose while the injury heals.
How long does the pain last?
It varies. Pain is usually worst early on, and some people develop nerve pain that can last for up to nine months. Pain relievers and cold compresses can help while you heal.
Will I have a scar after surgery?
Often very little. Oculoplastic surgeons commonly place incisions inside the eyelid or in natural skin creases to limit visible scarring. Ask your surgeon which approach they plan to use.
When is an orbital fracture an emergency?
Go to the nearest emergency room or call 911 if you have a sudden, severe headache, a seizure, difficulty walking, talking, or seeing, numbness or weakness in your body, blood or fluid leaking from your nose or ear, or fainting.
Can a black eye hide a fracture?
A black eye can look the same whether or not the bone is broken, so an exam and imaging are the only way to know. If bruising comes with double vision, trouble moving your eye, or numbness, get it checked.
What is the most common cause of these injuries?
In adults, assaults and car accidents are the most frequent causes. In children, car accidents and being hit in the face with a ball are the most common. Bike and motorcycle accidents, falls, and other sports injuries can also cause orbital fractures.
Do I need a specialist for this injury?
An ophthalmologist (eye doctor) examines the eye and orders imaging. If the fracture stops your eye from moving correctly or causes double vision, they may refer you to an oculoplastic surgeon, an ophthalmologist with special training in this type of surgery.
Can safety gear prevent these fractures?
Safety gear can lower the risk. Wearing a helmet or face mask for certain sports, a helmet on a motorcycle or bicycle, and a seat belt in a car can help prevent orbital fractures or reduce how severe they are.
References
Cleveland Clinic. Orbital fractures. Cleveland Clinic. Medically reviewed; last updated June 14, 2023. https://my.clevelandclinic.org/health/diseases/25075-orbital-fractures
Charmila IL, Wadde K, Yadav A, et al. Optimal timing for surgical intervention in orbital fracture management: a systematic review and meta-analysis. J Maxillofac Oral Surg. 2026;25(5):1291-1302. PMID: 42824282. DOI: 10.1007/s12663-025-02930-5
Miran B, Toneatti DJ, Schaller B, et al. Management strategies for isolated orbital floor fractures: a systematic review of clinical outcomes and surgical approaches. Diagnostics (Basel). 2025;15(23):3024. PMID: 41374405. DOI: 10.3390/diagnostics15233024
Asiri M, Aldowah O. Ocular findings in patients with orbital fractures: a 1-year prospective study in a tertiary center. Medicina (Kaunas). 2023;59(6):1091. PMID: 37374295. DOI: 10.3390/medicina59061091
Medical disclaimer
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about your health.
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