Orbital Floor Fractures 

An orbital floor fracture is a break in the thin bone that makes the “bottom” of the eye socket. Your eye sits in a bony cup called the orbit. The floor of this cup is very thin and lies on top of the maxillary sinus (an air space in the cheek). When a strong force hits the eye or cheek, pressure inside the socket can rise very fast. The thin floor may crack and drop. Soft tissues from the eye socket, like fat or eye-moving muscles, can sink or get trapped in the crack. This can cause double vision, a sunken-looking eye, pain, and numbness in the cheek or upper lip. Doctors also call this injury a “blow-out fracture.” It can happen alone or together with other facial fractures.

Your eye sits inside a bony cup called the orbit. The floor of that cup is thin bone between your eye and the maxillary sinus. A sudden blunt hit to the eye or cheek (sports ball, fist, dashboard) can raise pressure inside the orbit and crack or “blow out” the thin floor. Sometimes soft tissues (fat or eye-movement muscles) push through the crack into the sinus. This can cause double vision (diplopia), pain with eye movement, sunken-looking eye (enophthalmos), swelling, bruising, and numbness of the cheek/upper lip from irritation of the infraorbital nerve. In children, the bone can “hinge” like a trapdoor and pinch a muscle, triggering nausea, vomiting or even slow heart rate (oculocardiac reflex)—that’s an emergency and needs early surgery. eyewiki.org+1PMC+1

The orbital floor supports the eye from below. It separates the eye from the maxillary sinus in the cheek. It helps keep the eye in the right position so you can see single, clear images. It also protects and guides important nerves and blood vessels. One key nerve, called the infraorbital nerve (a branch of the trigeminal nerve), runs in a canal in the floor. This nerve gives feeling to the lower eyelid, the side of the nose, the cheek, and the upper lip. When the floor breaks, this nerve can be bruised or stretched. That can cause numbness or tingling in those areas. The eye-moving muscle that lifts the eye (the inferior rectus muscle) lies right on the floor. If the floor breaks and the muscle gets pinched in the crack, the eye may not move normally. That can cause double vision, especially when you try to look up. Because the floor is thin, even a round, soft object moving fast (like a ball) can push it down and break it. That is why these fractures are common in sports, falls, and crashes.

How the injury happens (mechanism)

A hard hit to the eye or cheek rapidly increases pressure inside the orbit. The pressure looks for a “weak escape path.” The thin floor is the weak point, so it breaks first. In some people, the force bends the floor like a hinge and then it snaps back, trapping soft tissue like a door on a finger. This “trapdoor” pattern is common in children and teens because their bones are more flexible. The break does not need to be open on the skin. Many orbital floor fractures happen with only swelling and bruising around the eye. Sometimes the surrounding rim bones also break. Sometimes air from the sinus leaks into the eyelids or cheek and makes a crackling feeling called crepitus.

Types of orbital floor fractures

1. Pure blow-out fracture (isolated floor): Only the floor breaks. The rim bones around the eye stay intact. The eye looks normal from the front rim, but the floor underneath is cracked.

2. Impure blow-out fracture (with rim or cheekbone break): The floor breaks and the bones around the eye rim or cheekbone also break. This is a bigger, more complex injury.

3. Trapdoor (hinge) fracture: The floor bends open during the hit and then springs shut. Soft tissues (often the inferior rectus muscle) get caught in the crack. Children often have this pattern. The skin may look less bruised, but the muscle can be tightly trapped.

4. Linear, non-displaced fracture: There is a hairline crack in the floor, but the pieces have not shifted. The eye may work fairly well, but symptoms like pain or numbness can still be present.

5. Comminuted fracture: The floor breaks into several pieces. The pieces can drop into the sinus. This can cause a sunken eye over time if the support is lost.

6. Entrapment fracture: Any floor break where soft tissues or a muscle are pinched in the gap. This often causes pain, nausea, slow heart rate (oculocardiac reflex), and double vision when looking up.

7. Non-entrapment fracture: The bone is broken, but soft tissues are not stuck. Symptoms may be milder and may improve as swelling goes down.

8. Medial extension fracture (floor–medial wall junction): The crack extends toward the inside wall of the orbit. This can involve the bone near the nose and can add to double vision risk.

9. Posterior floor fracture: The crack sits farther back in the socket. It can be harder to see from the front but shows up well on CT scans. It can still cause sunken eye or muscle problems.

10. Open vs. closed (skin): Most orbital floor fractures are “closed,” meaning the skin is not cut open. “Open” means there is also a skin wound. Open injuries raise infection risk and need careful cleaning.

11. Unilateral vs. bilateral: One side vs. both sides. Bilateral injuries are less common but can happen in major trauma.

12. Acute vs. late (delayed enophthalmos): Some people look okay at first, but the eye looks more sunken weeks later as swelling fades or as bone and soft tissues settle.

Common causes

1. Punch or fist to the eye or cheek (assault): A direct blow raises pressure in the socket and cracks the thin floor.

2. Fast sports ball (cricket, baseball, tennis): A small, fast ball hits the eye and forces the floor to give way.

3. Elbow or shoulder impact in contact sports: An accidental elbow to the orbit in basketball, football, or rugby can break the floor.

4. Motor vehicle collision (dashboard or airbag): The face hits a hard surface, or the airbag strikes the eye area with force.

5. Motorcycle or bicycle crash: A fall to the face or a handlebar hit can crack the floor.

6. Ground-level fall (especially in older adults): A simple fall onto the cheek can be enough because the floor is thin.

7. Workplace injury (tools or metal objects): A flying tool part or heavy object hits the orbit and breaks the floor.

8. Door edge or furniture corner impact: A sharp edge to the cheekbone area can focus force into the orbit.

9. Heavy object dropping onto the face: A box, tool, or weight that slips and strikes the eye region can cause a break.

10. Explosion or blast wave: A pressure wave from an explosion can transmit force into the orbit and fracture thin bone.

11. High-pressure air injury (compressed air mishap): Pressurized air directed at the face can push air into the orbit and stress the floor.

12. Domestic violence: Repeated or severe blows to the face can cause floor fractures and other facial injuries.

13. Contact sport pileups (rugby, hockey, soccer): Multiple bodies colliding can create a strong, misdirected hit to the orbit.

14. Scooter or e-scooter fall: A sudden stop and face-first fall can crack the floor.

15. Non-lethal projectile (paintball, BB): A small, fast pellet to the orbit can fracture the thin bone, even if the skin looks okay.

16. Chronic sinus disease with thinning bone plus minor bump: A long-standing sinus problem can thin the bone, so a minor hit then causes a fracture.

17. Prior sinus or orbital surgery weakening the floor: The bone may be thinner after surgery, so a new hit can break it more easily.

18. Bone-thinning conditions (like osteoporosis): Fragile bone breaks with smaller forces than normal bone.

19. Tumor or cyst eroding the orbital floor: A lesion can weaken the bone so a small force later causes a break.

20. Congenital thin spot or small bony gap (dehiscence): A person may be born with a weaker area that breaks with a moderate hit.

Key symptoms

1. Pain around the eye and cheek: The bone and soft tissues are bruised and inflamed, so touching the area hurts.

2. Swelling and bruising of the eyelids and cheek: Blood and fluid leak into the tissues, so the area becomes puffy and discolored.

3. Double vision (seeing two of one object): The eye may not move normally because a muscle is trapped or sore, so both eyes do not point the same way.

4. Trouble moving the eye, especially up or down: The inferior rectus muscle can be pinched, making upward or downward gaze limited and painful.

5. A sunken-looking eye (enophthalmos): The support under the eye is lost, so the eye may sit farther back in the socket. This may be more visible after swelling goes down.

6. Numbness or tingling in the lower eyelid, cheek, side of nose, or upper lip: The infraorbital nerve is bruised or stretched, so feeling is reduced or altered.

7. Tearing or watery eye: Swelling, irritation, or tiny surface scratches can make the eye water more than usual.

8. Nosebleed or blood in the nose: The crack often opens into the sinus, so blood can drain into the nose.

9. A crackling feeling under the skin (crepitus): Air leaks from the sinus into the eyelids or cheek and makes a crunchy feeling when pressed.

10. Headache or pressure in the face: Swelling and sinus involvement can create a heavy, aching feeling.

11. Blurred vision or dim vision: Swelling, corneal irritation, or more serious eye injury can reduce clarity. This is urgent if it does not improve quickly.

12. Nausea, dizziness, or slow heart rate when trying to look up (oculocardiac reflex): A trapped muscle can trigger a reflex that affects the heart and stomach, especially in children.

13. Pain when moving the eye: Inflamed or trapped muscles hurt when they are stretched or pulled.

14. Change in face shape (flattened cheek or asymmetric eyes): When the rim bones are also broken, the cheek may look flatter or the eyes may sit at different heights.

15. Blocked nose, cheek fullness, or sinus pressure: The nearby maxillary sinus can fill with blood or swell, causing congestion sensations.

Diagnostic tests

Physical exam tests

1. Visual acuity test (reading chart): You read letters on a chart. This shows how clearly you can see. A drop in vision suggests corneal, lens, retinal, or optic nerve injury and needs urgent attention.

2. Pupil exam and swinging-flashlight test: The doctor shines light in each eye and compares the pupil reactions. This helps spot optic nerve problems (an afferent pupillary defect), which is an emergency.

3. Eye movement and diplopia mapping in 9 gaze positions: You follow a target up, down, left, right, and diagonals. The doctor notes where movement stops or double vision appears. This helps locate a trapped or injured muscle.

4. Eyelid and orbital rim inspection and palpation: The doctor looks for cuts, swelling, and bruises, and gently feels for bone “step-offs” or tenderness. A step-off suggests a break in the bony rim or floor.

5. Infraorbital nerve sensation check (V2): Light touch or pinprick is tested on the lower eyelid, cheek, side of the nose, and upper lip. Reduced feeling points to infraorbital nerve injury.

6. Exophthalmometry (Hertel): A small measuring device checks how far each eye projects. A lower reading can indicate a sunken eye from a floor fracture.

Manual tests

7. Forced duction test (bedside or in the operating room): The eyelids are numbed, the eye is gently grasped with forceps, and the doctor tries to move it. If the eye cannot move passively in a certain direction, the muscle is likely mechanically trapped.

8. Force-generation test: You are asked to try to move the eye strongly in the limited direction while the doctor resists gently. Poor active force suggests muscle weakness or pain; a firm “stop” with good effort suggests mechanical entrapment.

9. Manual globe retropulsion through closed lids: The doctor gently presses the closed eye backward to feel tissue compliance. Reduced “give” can suggest herniated or trapped soft tissue or bleeding behind the eye.

10. Diplopia field plotting (red-glass or cover–uncover with prisms): Simple clinic tools map where double vision occurs and how far images are separated. This helps quantify the problem and track recovery after swelling or surgery.

Laboratory and pathological tests

11. Complete blood count (CBC): Checks for anemia from blood loss and looks for signs of infection (like high white cells) if there is an open wound or sinus infection.

12. Coagulation profile (PT/INR, aPTT): Important if there is significant bleeding, if you take blood thinners, or if surgery may be needed.

13. Beta-2 transferrin test (for clear fluid from nose): If clear fluid drips from the nose and a skull base leak is suspected, this lab test can confirm cerebrospinal fluid (CSF). A CSF leak needs special care.

Electrodiagnostic tests

14. Visual evoked potentials (VEP): Small scalp electrodes record brain responses to visual patterns. Weak signals can suggest optic nerve dysfunction when the eye exam is hard to interpret.

15. Infraorbital nerve conduction or blink-reflex studies: These nerve tests can document persistent infraorbital sensory loss after the fracture and help track recovery, especially in research or complex cases.

Imaging tests

16. Thin-slice non-contrast CT scan of the orbits (gold standard): A CT scan with very thin cuts and coronal/sagittal views shows the exact size and location of the floor break. It shows dropped bone fragments, air in soft tissues, herniated fat, and muscle position.

17. 3-D CT reconstruction (when helpful): A 3-D view helps the surgeon understand complex shapes and plan surgery for large or multi-piece fractures.

18. MRI of the orbits (soft-tissue detail): MRI shows the quality of the muscles, tendons, and optic nerve. It helps when entrapment is suspected but CT is unclear, or when there is concern for nerve injury or muscle scarring.

19. Plain X-ray (Waters view) (limited role): An X-ray can show sinus fluid levels or large bony defects, but it misses many details. CT is far more accurate, so X-ray is rarely used alone.

20. Ocular ultrasound (B-scan) with caution: Ultrasound can look for bleeding behind the eye or retinal detachment if the eyelids are too swollen to open. It should not be used if a globe rupture is suspected, because pressure on the eye can worsen the injury.

Non-pharmacological treatments (therapies and others)

1. Observation (“watchful waiting”) with scheduled follow-up
   Purpose: many fractures settle as swelling falls.
   Mechanism: edema resolves; diplopia often improves as the muscle moves freely again. Surgery is reserved for significant diplopia that limits daily life, large defects, or notable enophthalmos. eyewiki.org

2. Cold compresses/ice 10–15 minutes several times daily for 48–72 hours
   Purpose: reduce swelling and pain.
   Mechanism: slows local blood flow and inflammatory signaling.

3. Head elevation (extra pillows, avoid lying flat)
   Purpose: limit facial swelling.
   Mechanism: gravity helps venous/lymphatic drainage.

4. Strict nasal precautions
   Purpose: prevent orbital emphysema and pressure spikes.
   Mechanism: avoid nose-blowing, sneeze with mouth open, avoid Valsalva/straining for 2 weeks. MedscapeMDPI

5. Activity modification
   Purpose: protect the fracture.
   Mechanism: avoid heavy lifting, contact sports, diving, or straining while healing.

6. Soft diet
   Purpose: reduce pain and traction from chewing on fractured walls shared with the sinus.
   Mechanism: less masseter force reduces transmitted stress to the orbital floor.

7. Temporary occlusion (eye patch on one eye)
   Purpose: control bothersome double vision during the swelling phase.
   Mechanism: removing one visual input stops diplopia perception.

8. Temporary stick-on Fresnel prism (fitted by optometry/orthoptics)
   Purpose: align images to reduce diplopia while tissues recover.
   Mechanism: bends light to compensate for small misalignment.

9. Positioning and sleep hygiene
   Purpose: comfort and swelling control.
   Mechanism: supine or semi-upright; avoid sleeping on the injured side early on.

10. Protective eyewear
    Purpose: avoid re-injury.
    Mechanism: polycarbonate sports glasses once you resume light activity.

11. Wound/skin care (if a cut is present)
    Purpose: prevent infection and improve scar.
    Mechanism: gentle cleansing; later, sunscreen/silicone gel once approved.

12. Saline nasal irrigation/humidification
    Purpose: keep nasal passages clear without forceful blowing.
    Mechanism: low-pressure rinse reduces crusting and sneeze triggers.

13. Avoid air travel and scuba during the acute swelling phase
    Purpose: avoid pressure changes that can expand trapped sinus air.
    Mechanism: cabin/ambient pressure shifts can worsen emphysema after facial trauma. (Principle based on barotrauma literature; individualize with your surgeon.)

14. Smoking cessation
    Purpose: enhance bone and soft-tissue healing.
    Mechanism: smoking impairs bone repair and raises infection/nonunion risk. PubMedPMC

15. Avoid/reduce alcohol
    Purpose: improve healing quality.
    Mechanism: alcohol disrupts fracture callus formation and delays healing. PMC+1

16. Nutrition optimization (adequate calories/protein)
    Purpose: supply building blocks for collagen and bone.
    Mechanism: protein/energy support improves outcomes after fractures in some studies. PubMedPMC

17. Gentle range-of-motion guidance when cleared
    Purpose: decrease stiffness once entrapment is excluded.
    Mechanism: gradual ocular motility use helps neuromuscular adaptation.

18. Pain-coping strategies (rest, cold, short screen sessions)
    Purpose: reduce symptom spikes.
    Mechanism: lowers eye strain that worsens diplopia discomfort.

19. Prompt emergency care for “trapdoor” signs
    Purpose: prevent muscle necrosis and dangerous oculocardiac reflex.
    Mechanism: early release of entrapped muscle is protective (see “When to see a doctor”). PMC

20. Regular specialist follow-up (ophthalmology/OMFS/ENT)
    Purpose: re-check eye movements, globe position, and CT findings; decide on surgery timing.
    Mechanism: evidence-guided thresholds for surgery (diplopia affecting activities, enophthalmos, or entrapment). eyewiki.org

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Drug treatments

Doses below are typical adult references; your clinician will tailor for age, kidney/liver function, other meds, and local protocols.

1. Acetaminophen (paracetamol)
   Class: analgesic/antipyretic.
   Typical dose: 500–1,000 mg every 6–8 h (max 3,000–4,000 mg/day total).
   Purpose: first-line pain control.
   Mechanism: central COX inhibition; no effect on platelet function.
   Side effects: rare liver toxicity at high dose/alcohol use.

2. NSAIDs (e.g., ibuprofen/naproxen)
   Class: non-steroidal anti-inflammatory.
   Typical dose: ibuprofen 200–400 mg every 6–8 h; naproxen 250–500 mg twice daily with food.
   Purpose: pain and swelling relief.
   Mechanism: COX inhibition → less prostaglandin-mediated inflammation.
   Cautions/side effects: stomach/bleeding risk, kidney issues; avoid if facial bleeding risk is high—ask your surgeon.

3. Short-course oral corticosteroid (specialist-directed)
   Class: anti-inflammatory (e.g., prednisone short course).
   Purpose: select cases with severe orbital edema limiting exam or motility.
   Mechanism: reduces tissue edema around muscles/nerve.
   Cautions: glucose elevation, mood, infection risk—specialist decides. Medscape

4. Topical nasal decongestant (oxymetazoline 0.05%)
   Dose: 2 sprays each nostril up to twice daily, ≤3–5 days.
   Purpose: ease congestion without nose-blowing.
   Mechanism: α-agonist vasoconstriction.
   Side effects: rebound congestion if overused. Medscape

5. Antibiotics (only when indicated)
   Class: e.g., amoxicillin–clavulanate 875/125 mg twice daily 5–7 days; doxycycline 100 mg twice daily if penicillin-allergic.
   Purpose: for open fractures, contaminated wounds, sinus breach with symptoms, or surgery—not routinely for closed, non-operative fractures.
   Mechanism: covers sinus/oral flora.
   Evidence note: Prophylaxis is common but controversial; high-quality data show no benefit in closed, non-operative orbital fractures; recent trauma guidance advises against routine prophylaxis in those cases—follow local protocol. PMCPubMedtsaco.bmj.com

6. Artificial tears or lubricating gel (OTC)
   Purpose: soothe surface irritation if eyelid closure is incomplete or blinking is reduced.
   Mechanism: protects cornea while swelling settles.
   Side effects: temporary blur with gels.

7. Antiemetic (ondansetron)
   Dose: 4–8 mg orally/ODT as needed.
   Purpose: reduce vomiting that could raise sinus/orbital pressure; useful if oculocardiac symptoms present while awaiting care.
   Mechanism: 5-HT3 blockade.

8. Tetanus vaccination (as indicated)
   Purpose: standard wound prophylaxis if laceration/soil exposure and immunization is out of date.
   Mechanism: stimulates protective antibodies.

9. Intranasal saline spray/rinse
   Purpose: maintain moisture and clearance without force.
   Mechanism: isotonic mechanical rinse; non-addictive alternative to decongestants.

10. Stool softener (e.g., docusate 100 mg twice daily)
    Purpose: avoid straining/Valsalva during early healing.
    Mechanism: lowers stool surface tension to ease passage.

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Dietary molecular supplements

Supplements support recovery; they do not fix a fracture. Discuss with your clinician if you’re pregnant, on blood thinners, or have kidney stones/liver disease.

1. Vitamin C (ascorbic acid) 500–1,000 mg/day
   Function/mechanism: co-factor for collagen cross-linking; deficiency impairs bone healing; several studies suggest improved collagen and oxidative stress profiles. Wiley Online LibrarySAGE Journalsopenorthopaedicsjournal.com

2. Calcium (diet first; supplement to reach ~1,000–1,200 mg/day total)
   Function: mineral for bone matrix.
   Mechanism: provides substrate for mineralization; best paired with vitamin D. PMC

3. Vitamin D3 (typical maintenance 800–2,000 IU/day; tailor to level)
   Function: aids calcium absorption and bone metabolism.
   Mechanism: maintains 25-OH-D sufficiency; benefit for healing alone is uncertain, but D with calcium reduces fracture risk. PMC+1New England Journal of Medicine

4. Protein (food first; add whey/casein if intake is low to hit ~1.0–1.2 g/kg/day)
   Function: amino acids for collagen and muscle recovery.
   Mechanism: improves outcomes after fractures in some trials. PubMed

5. Zinc (8–11 mg/day; short-term 15–25 mg/day if advised)
   Function: enzyme co-factor in collagen synthesis.
   Mechanism: supports osteoblast function; associated with bone density. PMC

6. Magnesium (200–400 mg/day)
   Function: bone mineral; many diets are low.
   Mechanism: influences bone turnover. PMC

7. Vitamin K2 (MK-7) 90–180 mcg/day (avoid with warfarin unless cleared)
   Function: carboxylates osteocalcin.
   Mechanism: supports bone mineralization pathways. PMC

8. Omega-3 (EPA+DHA ~1 g/day from fish/fish oil)
   Function: anti-inflammatory support.
   Mechanism: may decrease inflammatory cytokines and support bone cells; human data are mixed but supportive. PMC+1Frontiers

9. Silicon (orthosilicic acid 10–20 mg/day)
   Function: collagen and glycosaminoglycan support.
   Mechanism: associated with bone quality in observational work. PMC

10. Boron (1–3 mg/day) and Copper (~1 mg/day)
    Function: trace cofactors for bone metabolism and collagen enzymes.
    Mechanism: may help bone mineralization when dietary intake is low. PMC

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Regenerative/immune/biologic” options

There are no approved “stem-cell drugs” or immunity-booster pills that heal an orbital floor fracture. Some biologic adjuncts are studied mainly in oral/maxillofacial or long-bone settings. These are specialist-only, often off-label, and not routine for simple orbital fractures:

1. Teriparatide (PTH 1-34), 20 µg subcutaneously daily (off-label for nonunion)
   Function/mechanism: anabolic bone agent that can speed callus formation in some delayed unions. Emerging RCT and observational data support improved healing time in selected fractures; not standard for orbital wall fractures. PMCNature

2. rhBMP-2 (recombinant bone morphogenetic protein-2) applied locally on a collagen sponge (dose varies by product)
   Function: osteoinductive growth factor.
   Mechanism/notes: used in certain craniofacial reconstructions but carries risks (ectopic bone, inflammation/edema) and strict indications; pediatric use is restricted. PMC+1ScienceDirect

3. BMAC (bone marrow aspirate concentrate)
   Function: concentrates progenitor cells and growth factors.
   Mechanism: osteogenic support when combined with grafts; data growing in maxillofacial bone work. PMCsci.amegroups.org

4. PRP/PRF (platelet-rich plasma/fibrin) — autologous
   Function: platelet growth factors.
   Mechanism: may enhance soft-tissue and bone healing when combined with grafts; results mixed; protocols vary. PMCBioMed Central

5. Bioactive glass implants (surgical material, not a “drug”)
   Function: scaffold that bonds to bone; may be antimicrobial-unfriendly.
   Mechanism: osteoconductive/osteoactive properties in orbital wall reconstruction. PubMed+1

6. Resorbable polymer plates/sheets (PDS, PLA/PGA)
   Function: temporary support that dissolves over months.
   Mechanism: holds the floor while bone heals; chosen based on defect size and load. PubMed+1

Bottom line: these are specialist choices for selected surgical reconstructions—not take-home “immune boosters.”

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Surgeries

1. Transconjunctival orbital floor repair with implant
   What happens: incision inside lower eyelid; the surgeon frees any trapped tissue, re-creates normal shape, and places an implant (porous polyethylene, titanium mesh, or resorbable sheet) to cover the defect.
   Why: persistent diplopia with entrapment, significant enophthalmos, or large floor defect interfering with function or appearance. eyewiki.org+1

2. Subciliary (just under eyelashes) open approach
   What happens: external skin crease incision to access the floor; used selectively.
   Why: surgeon preference, revision, or anatomy that needs wider exposure. eyewiki.org

3. Endoscopic endonasal/transantral repair
   What happens: sinus entry via nose/upper gum with endoscope; elevates herniated tissue and supports the floor from below.
   Why: avoids eyelid incision; useful for certain medial or floor defects. eyewiki.org

4. Urgent “trapdoor” release in children
   What happens: rapid surgery to free an entrapped extraocular muscle.
   Why: stops the oculocardiac reflex and prevents muscle ischemia; timing matters. PMC+1

5. Secondary reconstruction/revision
   What happens: later surgery to adjust implant or volume if late enophthalmos/diplopia persists.
   Why: improves function/appearance when initial healing leaves a deficit. (Material choice may include titanium mesh, porous polyethylene, bioactive glass, or resorbables based on defect and surgeon judgment.) PMCMDPI

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Prevention tips

1. Wear sport-rated polycarbonate eye protection in risk sports.

2. Use seatbelts/shoulder restraints; check airbags.

3. Wear helmets/face shields for bikes, motorcycles, and contact sports.

4. Practice workplace eye safety (guards, shields, PPE).

5. Reduce interpersonal violence risks (conflict-avoidance strategies).

6. Fall-proof your home: lighting, handrails, non-slip mats.

7. Correct poor vision and avoid walking with deep bifocal segments.

8. Treat osteoporosis risk factors (calcium, vitamin D, weight training, DXA as advised).

9. Quit smoking; it raises fracture risks and delays healing. Nature

10. Limit alcohol—binge patterns impair bone repair. PMC

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When to see a doctor

• Call emergency services or go to the ER now if you have:
  • Nausea/vomiting, dizziness, or slow heartbeat with eye movement (possible child “trapdoor” fracture with oculocardiac reflex) • Severe eye pain or cannot move the eye up/down • Rapid swelling, crackling under the skin, or vision drop after blowing your nose • Open eye injury or vision loss. PMC+1

• See an eye/face specialist within 24–72 hours if you have:
  • Persistent double vision, cheek numbness, or a sunken-looking eye • Pain with eye movement • Any concern after facial trauma. Decisions about surgery vs observation are usually made over the first 1–2 weeks as swelling settles. eyewiki.org

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What to eat and what to avoid

1. Eat protein with every meal (eggs, fish, dairy, legumes, lean meat) to reach ~1.0–1.2 g/kg/day—supports collagen and muscle recovery. PubMedPMC

2. Calcium + Vitamin D from foods (milk/yogurt, small fish with bones, fortified foods) and supplements if your doctor advises—supports bone mineralization. PMC

3. Vitamin C–rich produce (citrus, berries, kiwi, peppers) for collagen cross-linking. Wiley Online Library

4. Zinc & magnesium sources (nuts, seeds, whole grains, beans) for enzyme co-factors in bone repair. PMC

5. Fatty fish 2–3×/week (or omega-3 supplements if advised) for anti-inflammatory support. PMC

6. Hydrate well; dehydration worsens headaches and congestion.

7. Limit salt and ultra-processed foods (soups, chips, instant noodles) to reduce fluid retention and blood pressure while swollen. AHA Journals

8. Avoid alcohol, especially binge drinking; it slows fracture healing. PMC

9. If caffeine sensitive, keep amounts moderate to avoid sleep loss and jaw clenching.

10. Don’t smoke; it clearly impairs bone healing. PubMed

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FAQs

1) How long does an orbital floor fracture take to heal?
Bone edges start knitting within 6–8 weeks, but swelling and double vision can improve earlier. Some numbness may take months to fade. Your team checks progress and decides about surgery if problems persist. eyewiki.org

2) Will my double vision go away?
Often yes as swelling falls. If a muscle is entrapped, surgery may be needed. Temporary prisms or an eye patch can help meanwhile. eyewiki.org

3) What are the main reasons to operate?
Function-limiting diplopia, significant enophthalmos, large floor defects, or muscle entrapment/oculocardiac reflex (urgent). eyewiki.orgPMC

4) I blew my nose and the eyelids puffed up—what now?
Stop blowing, keep head elevated, use cold compresses, and seek care—air may have leaked into the orbit (orbital emphysema). PMC

5) Can I fly?
Discuss with your surgeon. Many clinicians avoid air travel in the first couple of weeks after facial trauma to reduce barotrauma risk, especially if emphysema occurred.

6) Are antibiotics always needed?
No. Evidence does not support routine antibiotics in closed, non-operative orbital fractures. They’re used if there’s an open wound, sinus infection, or surgery. Follow local protocols. PMCPubMedtsaco.bmj.com

7) Which implant is best if I need one?
Options include porous polyethylene, titanium mesh, resorbable polymers, or bioactive glass. Surgeons choose based on defect size, durability needs, and your anatomy. All have good outcomes in selected cases. PMCPubMed+1

8) Is there any “stem-cell shot” to fix this?
No approved stem-cell drug heals an orbital floor fracture. Some biologics (PRP/PRF, BMAC, rhBMP-2) are used selectively in reconstructive surgery but aren’t routine for simple fractures and can carry risks. PMC+2PMC+2

9) My child was hit but looks “normal” and just feels sick when looking up—worry?
Yes—children can have a “white-eyed” trapdoor fracture with minimal bruising but muscle entrapment and oculocardiac reflex. Seek urgent care. eyewiki.org

10) Will the cheek/upper lip numbness recover?
Often improves over weeks to months as the infraorbital nerve calms, but recovery varies by injury.

11) Can I take ibuprofen?
Often yes, but check with your surgeon, especially right after injury/surgery. NSAIDs help pain/swelling but can irritate the stomach and affect bleeding risk.

12) How soon can I exercise?
Walk right away if comfortable. Avoid heavy lifting, straining, and contact sports until your surgeon clears you.

13) Can this fracture affect my vision permanently?
True globe injuries are less common but serious. Early exams rule these out. Most floor fractures managed properly do not cause permanent vision loss.

14) How do surgeons decide on timing?
Many cases are observed for a short period; urgent repair is done for entrapment. Otherwise, repair is considered if diplopia or enophthalmos remains after swelling subsides. eyewiki.org

15) Will I look different?
Good repairs aim to restore the orbital volume and alignment. Mild enophthalmos can remain in some cases; revision is possible if needed. PMC

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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 18, 2025.

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