Orbital fractures and bespoke implants

What are orbital fractures?

Fractures of the orbit essentially involve the eye socket, most commonly the floor of the socket as this is the weakest part of the bone. Commonly as a result of a direct hit to the eye, the floor can “give way”, causing a prolapse of fat and muscles into the sinus cavity below.

What symptoms might I have?

Initially you may have bruising around the eye and potentially a bloodshot eye as well, called a periorbital haematoma and subconjunctival haemorrhage respectively. There may be difficulty moving the eye and, as a result, double vision. As the swelling subsides, a relative asymmetry in the eyes can become apparent, as the eye is sunk backwards (enophthalmos) and downwards (hypoglobus) in its socket relative to the other eye.

How is surgery performed?

Surgery is performed asleep (under general anaesthesia). Using aesthetic incisions hidden around the eyelid, the orbital floor is accessed and repaired. In more complex defects, I will ensure that a bespoke or custom implant is made. This is “made to measure” for your orbital cavity and only fits you! It is usually based on a mirror image of the other side and fits precisely to restore anatomy to the way it was, supporting your eye and allowing things to move naturally again.

What are the risks of surgery?

The risks of surgery are pain, swelling, bleeding, infection, scarring, hypertrophic or keloid scarring, distortion of the eyelid (ectropion or entropion), temporary/permanent sensory alteration, persistent double vision and (exceedingly rarely) loss of vision. Most people have uneventful surgery besides some bruising and swelling and make a full recovery.

Will I need to stay overnight?

Yes, as you will need to have close monitoring of your eye including pupil reflexes, visual acuity, eye movements and pain. This will be done with gradually reducing frequency overnight to ensure that you are safe for discharge.

What is recovery like?

Generally, you can expect to have some bruising and a reappearance of the black eye you may have had with the initial trauma. Things may feel quite numb for some weeks afterwards and in the acute phase, the double vision can actually be worse due to swelling. Everything should settle down within a few weeks.