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An excerpt from the book Taking Care of Your Eyes.

Taking Care of Your EyesEach of your eyeballs lies within an orbit (eye socket), an open cavity within the skull that is bordered by very thin bone. If your eye or eye region is hit, as by a fist or ball, it can cause the pressure within the orbit to suddenly increase. The result can be a blowout fracture – a break in one of the orbit bones and the possibility of the nerves and extraocular eye muscles in the orbit being pushed through the break. A blowout fracture of the orbit can be a very serious injury.


If any blood vessels have been broken, blood will swell into the tissues and cause a classic swollen "black eye." After the swelling goes down, the eye may appear to be sunken back because the tissues have been pushed out of the orbit through the broken bone. You may also have double vision (diplopia) whenever you look up or down. Occasionally the lower part of the cheek and some of the upper back teeth on the same side as the fractured orbit become numb. Very rarely, severe pain and nausea occur immediately after the injury.


Since the eye may have been hit directly, it will be thoroughly examined to determine the extent of the injury. Your vision will be evaluated and the inside of the eye will be examined with an opthalmoscope. If a blowout fracture is suspected, various X-rays may be taken of the orbital bones and other facial bones. If swelling is so severe as to make a thorough eye examination painful, or even hazardous, it may be postponed for a few days. It may be necessary to wait a week or two for the swelling to go down before a decision can be made as to final treatment.


Treatment of any injuries to the eyeball will depend on the type and extent of the damage. If there is no serious injury except for the bone of the orbit, it may be allowed to heal without any treatment. But if it appears that double vision or a sunken eyeball might be permanent, it may be necessary to surgically repair the fractured bone, possibly sealing the hole with a thin plastic implant.

Surgical repair of a "blowout" is rarely undertaken immediately and can safely be postponed for up to two weeks if it is necessary to let the swelling subside. Surgery to place an orbital implant leaves little or no scarring and the recovery period is usually brief. Hopefully, the surgery will provide a permanent cure, but sometimes it provides only partial relief from double vision or a sunken eye.

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