What is Orbital Floor Fracture With Entrapment

The orbital floor is the bottom wall of the eye socket (orbit). An orbital floor fracture with entrapment is a break in the orbital floor that allows nearby muscle, tissue, or both to get trapped inside of the fracture. This usually causes swelling and pain, and often affects (impairs) vision.

Treatment depends on how severe your entrapment is, and how old you are. In most cases, you will take medicine until your swelling goes down. Then your health care provider will evaluate whether you need more treatment, such as surgery. Children can get a type of fracture that requires surgical treatment sooner (trapdoor fracture). Orbital fractures with entrapment are often more serious in children than in adults.

What are the causes?

This condition is caused by an injury to the eye, such as a hard, direct hit.

What are the signs or symptoms?

Symptoms of this condition include:

• Swelling and bruising around the eye, causing a “black eye” appearance.
• A crunching sound when pressure is placed on or around the eye area, such as when the eyelid is touched.
• Seeing two of everything (“double vision”), with one object appearing higher than the other (vertical diplopia). This may get worse when you look up.
• Inability to move the eye or look in a certain direction (palsy).
• Pain around the eye when you look up.
• One eye looking sunken compared to the other eye (enophthalmos).
• Numbness of the cheek, inner nose, and upper gum on the same side of the face as the injury.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• An eye exam.
• An X-ray or CT scan.

How is this treated?

This condition may first be treated with medicines, such as one or more of the following:

• Antibiotics to treat or prevent infection.
• Steroids to reduce swelling.
• Decongestants to help relieve sinus stuffiness (congestion).
• Medicines to reduce pain.

The fracture itself is usually not treated until all the swelling around the eye has gone away. This may take 1–2 weeks. After your swelling goes away:

• If you have persistent vertical double vision, an eye specialist (ophthalmologist) may try to free the entrapped tissue. If this is not possible, you may need surgery.
• If you have double vision only when looking up, your health care provider will discuss treatment options with you. Some people who do not spend a lot of time looking up choose not to have more treatment. Others who need to look up often, such as electricians, need treatment.

You may need surgery sooner than later if you have:

• A trapdoor fracture.
• Symptoms of a nervous system response (oculocardiac reflex) such as:
  • Nausea or vomiting.
  • A slow heart rate.
  • Dizziness.
  • Loss of consciousness.

Follow these instructions at home:

Safety

• Do not drive or perform your regular activities without your health care provider’s approval. Be aware that if you are only using one eye to see, you may have difficulty judging distances (depth perception).

Eye care

• Always follow recommendations about wearing protective glasses or goggles.
• Do not wear contact lenses until your health care provider says it is okay.

Managing pain and swelling

• If directed, put ice over your eye area to help reduce swelling:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• If recommended by your health care provider, sleep with one or two extra pillows under your head. Keeping your head raised slightly when lying down can help with swelling and pain.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

General instructions

• Do not touch, rub, or try to move your eye.
• Do not blow your nose until your health care provider says it is okay.
• Stay away from dusty areas.
• Avoid traveling by plane or going to high-altitude areas until you recover. These activities may slow the healing of your swelling and may increase sinus pain.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have vision changes, such as double vision that gets worse.
• Notice that the redness or swelling around your eye gets worse instead of better.
• Notice blood or fluid starting to leak from your nose.
• Have a fever.

Get help right away if you:

• Have a sensation that you are seeing flashing lights.
• Have sudden blindness.
• Have nausea or vomiting.
• Notice that your heart is beating much slower than normal.
• Have chest pain.
• Are light-headed.
• Are short of breath.

Summary

• An orbital floor fracture with entrapment is a break in the orbital floor that allows nearby muscle, tissue, or both to get trapped inside of the fracture.
• This condition may cause you to see two of everything, with one object appearing higher than the other (vertical diplopia).
• The fracture itself is usually not treated until all the swelling around the eye has gone away. This may take 1–2 weeks.
• You should not drive or perform your regular activities without your health care provider’s approval.