Doubling
Objects double, especially when looking up or down.
CONDITION / FACE
Orbital fracture and inflamed eye.
An orbital fracture is a break in the thin bony walls of the eye socket after an impact. It can cause diplopia, numbness of the cheek and sunken eye (enophthalmos); some of the fractures are treated without surgery, and some - by restoring the wall with an implant.
CONCEPTUAL VISUALIZATION- What it is
- Breakage of the thin walls of the eye socket, most often the fundus, after a blow to the eye area.
- What threatens
- Double vision, numbness of the cheek, sunken eye; in children - pinching of the eye muscle.
- When surgery is performed
- Entrapment in children — within 24–48 hours; other fractures, if needed, usually in the first 2 weeks.
- Who treats it
- A surgeon who operates on facial bones together with an ophthalmologist.
01 / WHAT IS ITWhat is
What is
orbital fracture.
The orbit is a bony cavity in which the eye lies along with muscles, fat and nerves. An orbital fracture is one of the frequent fractures of the face, and fractures of its bottom are frequent consequences of a blow to the eye.
After such a fracture, double vision is possible because the eye muscle is pinched or damaged, numbness of the cheek and upper lip, and drooping of the eye — doctors call it enophthalmos. Enophthalmos may appear not immediately, but later, when the swelling subsides.
Post-traumatic enophthalmos - when the eye remains inflamed after a long-standing fracture. It is corrected as planned, even if the injury was long ago.
This is general information. The doctor will tell you what will suit you after the examination and CT scan.
02 / SIGNSHow
How
orbital fracture presents.
Immediately after the impact, swelling and bruising can hide some of the symptoms, so it is important to re-examine when the swelling subsides.
The eye does not move well
The eye does not keep up with the second or hurts when you move it.
The eye fell
An eye sitting deeper or lower than the other is enophthalmos.
Cheek numbness
The cheek, the side of the nose or the upper lip do not feel the touch well - the nerve under the eye is damaged.
Bruising and swelling
A normal bruise around the eye goes away in 2-3 weeks; if not, see a doctor.
"White eye" in a child
Outwardly, the eye may look almost intact, but the child cannot move it, is nauseous or vomiting, and the pulse is slow.
03 / REASONSWhy do they break?
Why do they break?
walls of the orbit.
Whether an operation is needed and how quickly depends on how exactly the wall broke.
hit
A punch, fall or other blow to the eye area.
Children's bones
Bones in children are elastic: the fragment "springs" back and clamps the muscle or fat. Such fractures ("trapdoor") are typical for children.
A big breakthrough
The larger the area of the break and the greater the orbital volume on CT, the higher the risk that the eye will eventually sink.
Changes over time
Without surgery, late enophthalmos develops in 7–10% of patients; the gradual reduction of fat in the orbit may play its role.
Inaccurate recovery
Among those who required repeat surgery, the most common problem was an improperly placed implant. Bones that have fused with displacement also change the position of the eye.
Post-traumatic deformations of the face
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A blow to the eye with a suspected fracture is a reason to see a doctor the same day. Some signs mean that blood may be pooling behind the eye and increasing the pressure in the eye socket - then help is needed immediately to save vision.
103 immediately if:
- vision has worsened or disappeared;
- severe pain in or around the eye that grows;
- the eye protrudes forward;
- the eye became tense and hard;
- swollen eyelids do not open;
- a new double appeared;
- the eye does not move;
- the child vomits or is very nauseous after being hit in the eye;
- the child's pulse slowed down after being hit in the eye;
- after a blow to the head, a person lost consciousness;
- a clear liquid flows from the nose.
Do not delay a visit to the doctor:
Immediately - to the reception department: blood inside the eye, an irregularly shaped pupil, flashes, halos or shadows in front of the eye, pain from bright light, bruising around both eyes, or vomiting after a blow to the head. Do not get behind the wheel - let them take you or call 103. On the same day: numb cheek or upper lip, pain when moving the eye, headache that does not go away. Do not worry: with a fracture of the wall, air from the nose can enter the eye socket. In the coming days: if the operation was not prescribed - a repeat examination so as not to miss diplopia or sinking of the eye. Planned: if the fracture is long-standing, and the eye is sunken or double, make an appointment for a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
whether surgery is necessary.
- Discussion and review
How the blow happened; the position of the eye compared to the second, eye movements, cheek sensitivity.
- Ophthalmologist's examination
In the case of an orbital injury, it is mandatory: vision, the eye itself, and the movements of the eye muscles are checked.
- CT of the facial skull
Shows which wall is broken and if tissues are pinched. The area of the break and the change in orbital volume help predict whether the eye will droop.
- Mobility test
The doctor checks whether the eye moves freely, or whether something is holding it back - this is how a pinched muscle is detected.
06 / TREATMENTHow we treat
How we treat
orbital fracture.
Not every orbital fracture needs surgery. Decisions are made based on symptoms and CT scan. There are no randomized studies on the timing of the operation, so tactics are determined individually.
01
Follow-up
If there is no pinching and a large breach.
- Without surgery
- If the diplopia is mild or goes away, and the eye is not sunken, surgery may not be necessary. In a series of 79 patients, 36 were treated without surgery.
- Control
- Even without surgery, late enophthalmos develops in approximately 7–10% of patients, so repeat examinations are necessary.
- The first days
- Cold on the eye area for 10–20 minutes in the first 1–2 days, do not rub or press on the eye, do not take aspirin without a doctor's prescription, do not scratch.
02
Urgent operation
When tissues are pinched.
- "Trapdoor" in children
- If the movements of the eye are sharply limited, the child is nauseous or the pulse has slowed down, the operation is recommended as soon as possible - within 24-48 hours: the pinched muscle suffers from a lack of blood, and diplopia may remain.
- "White Eye"
- A fracture with external pinching can be almost imperceptible - this is not a reason to wait. Doubtful CT findings should not delay surgery.
03
Planned operation
Usually in the first 2 weeks.
- when
- If the diplopia does not go away and the CT scan shows pinching of tissues or a large break, which can cause an inflamed eye. In a meta-analysis of 1,283 patients, surgery in the first 14 days was less likely to cause diplopia and enophthalmos than later surgery.
- How
- The wall of the orbit is restored with an implant through an incision on the inner surface of the eyelid or under the eyelashes. An incision on the inner surface less often gives an inversion of the eyelid and a noticeable scar, but more often - an inversion of the eyelid.
- Individual implant
- It is made under the CT just under the patient's orbit. In a meta-analysis of 628 adults, enophthalmos remained in 11.2% with individual implants versus 19.2% with standard implants, but no statistically significant difference was found — the choice depends on the surgeon.
- 3D models
- In a review of 906 cases, orbital reconstruction with 3D-printed models restored volumetric symmetry and reduced diplopia and enophthalmos; how much is from 3D printing has yet to be determined.
04
Late correction of enophthalmos
When the eye has sunk in.
- The result
- In a series of 41 patients, after late correction, the position of the eye was corrected to a difference within 2 mm in 37, and diplopia after all stages of treatment was significantly reduced in 65.9%.
- If the doubling remains
- Eye muscle surgery or glasses with prisms help: in the same series, 10 and 4 patients needed them.
- In children
- The authors of the review advise not to operate for the prevention of enophthalmos, but to wait until it becomes noticeable.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Orbital fractures at Dr. Valikhnovskyi's Institute of Surgery are treated in the "New Face" direction, along with fractures of the cheekbones, jaws, and post-traumatic facial deformities. The condition of the eye and vision before and after the operation is evaluated by an ophthalmologist.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Restoration of the wall of the orbit — according to indications, the wall is restored with an implant to return the eye to its correct position.
- Individualized orbital implant — an orbital mesh made of medical titanium or PEEK is made according to a 3D model, and it repeats the anatomy of your orbit.
- Mirror CT modeling — the healthy half of the face is mirrored on the damaged one and a plan of the bones and contour is obtained.
- Cartilage graft — the patient's own cartilage to restore the position of the eye and eyelids.
- Osteotomy and titanium plates — bones that have fused with displacement are dissected and rearranged; fragments are fixed with plates.
- Correction of the position of the eyelids — if the eyelid drooped or everted after an injury — canthopexy, canthoplasty, spacers for the lower eyelid.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- CT scan and photo onlineSend CT scans, discharges and photos of the face - the doctor will pre-evaluate the situation.
- ConsultationExamination of the position and movements of the eye, sensitivity of the cheek; examination by an ophthalmologist.
- PlanIs surgery necessary, when and with which implant; if necessary, 3D planning.
- SurgeryRestoration of the wall of the orbit with an implant, if necessary, together with the cheekbone or eyelids.
- RecoverySwelling and bruising are greatest in the first days; diplopia due to edema usually gradually decreases. Do not touch until the surgeon gives permission.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it always necessary to operate on an orbital fracture?
No. If the diplopia is mild or transient, the eye is not sunken, and there is no entrapment or large break on the CT scan, the fractures are monitored with repeated examinations.
How long can I wait for surgery?
When a muscle is pinched in children — within 24–48 hours. In other cases, if surgery is required, it is advised in the first 2 weeks: in the meta-analysis, diplopia and enophthalmos remained less often.
Why didn't the eye fall immediately?
At first, swelling masks subsidence. Without surgery, late enophthalmos develops in approximately 7–10% of patients, so repeated examinations are important after the fracture.
Will the doubling happen?
The diplopia due to edema usually gradually decreases. In children who have been operated on for diplopia, approximately 85% recover completely over time. The doctor will tell you what to expect after the examination.
Is it possible to fix a sore eye if the injury was long ago?
Yes, planned. In a series of 41 patients, after late correction, the position of the eye was adjusted to a difference of 2 mm in 37.
Why can't you move after a fracture of the orbit?
When the wall between the orbit and the sinus is broken, air from the nose can enter the eye socket. Therefore, do not rush until the doctor allows, and ask him about flights.
What is better — individual or standard implant?
According to research reviews, the results are in average comparison; individual implants accurately reproduce the anatomy, and the choice is made for a specific fracture.
Sources
18 sources · guidelines, systematic reviews, meta-analyses and the NHSshowCollapse
- Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysisOphthalmology, 2002doi:10.1016/s0161-6420(02)01057-6 ↗
- Pediatric orbital blowout fracturesCurrent Opinion in Ophthalmology, 2017doi:10.1097/ICU.0000000000000407 ↗
- Pediatric Orbital FracturesOral and Maxillofacial Surgery Clinics of North America, 2023doi:10.1016/j.coms.2023.05.002 ↗
- Does Early Treatment of Paediatric Orbital Fracture Offer Any Advantage in Terms of Post-Operative Clinical OutcomesJournal of Maxillofacial and Oral Surgery, 2022doi:10.1007/s12663-021-01543-y ↗
- The better surgical timing and approach for orbital fracture: a systematic review and meta-analysisAnnals of Translational Medicine, 2022doi:10.21037/atm-22-1465 ↗
- Management of pure orbital floor fractures: a proposed protocol to prevent unnecessary or early surgeryOrbit, 2014doi:10.3109/01676830.2014.902475 ↗
- Predictors of Delayed Enophthalmos After Orbital Fractures: A Systematic ReviewFacial Plastic Surgery & Aesthetic Medicine, 2022doi:10.1089/fpsam.2021.0177 ↗
- What Computed Tomography Findings Are Predictive of Posttraumatic Enophthalmos in Orbital Fractures?Plastic and Reconstructive Surgery, 2025doi:10.1097/PRS.0000000000011609 ↗
- Orbital reconstruction: a systematic review and meta-analysis evaluating the role of patient-specific implantsOral and Maxillofacial Surgery, 2023doi:10.1007/s10006-022-01074-x ↗
- Patient-specific Implants for Orbital Fractures: A Systematic ReviewOphthalmic Plastic and Reconstructive Surgery, 2022doi:10.1097/IOP.0000000000002089 ↗
- Three-dimensional (3D) printing for post-traumatic orbital reconstruction, a systematic review and meta-analysisBritish Journal of Oral and Maxillofacial Surgery, 2022doi:10.1016/j.bjoms.2022.07.001 ↗
- Functional Outcomes of Late Posttraumatic Enophthalmos CorrectionPlastic and Reconstructive Surgery, 2018doi:10.1097/PRS.0000000000004600 ↗
- Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic ReviewFacial Plastic Surgery, 2022doi:10.1055/s-0041-1740290 ↗
- Orbital Compartment SyndromeBeyoglu Eye Journal, 2019pubmed.ncbi.nlm.nih.gov/35187423 ↗
- Orbital Fractures and Air TravelJournal of Craniofacial Surgery, 2021doi:10.1097/SCS.0000000000007529 ↗
- Black eyeNHS, 2023nhs.uk/conditions/black-eye ↗
- Double visionNHS, 2024nhs.uk/symptoms/double-vision ↗
- Vision lossNHS, 2025nhs.uk/conditions/vision-loss ↗
The figures on the page are from these sources.
After the impact
double or sunken eye?
Submit CT scans and facial photos. The doctor will tell if the operation is necessary and when it is better to do it.