Does every blowout fracture need surgery?
No. Some fractures can be monitored while swelling settles.
Trapped tissue, persistent double vision, eye position, and CT findings help determine whether repair is appropriate.
Reconstructive Surgery
Orbital Floor (Blowout) Repair
Orbital floor repair rebuilds the bone beneath the eye after a blowout fracture to support eye position and movement.
Can repair restore vision?
It supports the eye socket, but it does not repair every cause of vision loss.
Injuries to the eyeball, retina, or optic nerve need their own assessment and treatment.
How soon is treatment needed?
Some injuries need urgent treatment; others are reassessed after swelling decreases.
Do not wait for a routine consultation if you have new vision loss, severe eye pain, or difficulty moving the eye after an injury.
01 · Overview
Understanding orbital floor repair
The orbital floor is the thin bone separating the eye socket from the sinus below it. A blowout fracture can allow fat or other tissue to slip through the break. Eye muscles or nearby tissue may become trapped, limiting movement. [1]
Assessment usually includes vision, pupils, eye movement, facial sensation, and CT imaging. An eye specialist may also check for injuries inside the eye. Decisions about repair depend on these findings, not bruising alone. [1]
During repair, the surgeon frees displaced or trapped tissue and rebuilds support beneath the eye, often with an implant. This is different from cosmetic eyelid surgery, repair of the eyeball itself, or treatment of every fracture around the eye socket. [1]
- Area treated
- Bone beneath the eye
- Main purpose
- Restore socket support and release trapped tissue when present
- Assessment
- Eye examination and usually CT imaging
- Anesthesia
- Usually general anesthesia
Why might the team wait before deciding on surgery?
Swelling can temporarily cause double vision or hide a change in eye position. When there is no urgent finding, repeat examinations may show whether symptoms are improving without surgery.
Why are some injuries urgent?
Trapped tissue can impair eye movement and sometimes cause nausea, vomiting, or a slowed heartbeat. Children may have this type of injury with little bruising. Suspected entrapment needs prompt specialist assessment.
02 · Concerns & Goals
What may bring you to care
An injury around the eye can affect vision, eye movement, and facial feeling. Prompt assessment helps separate swelling from problems that need treatment.
Double vision
You may see two images, especially when looking up or down. Swelling, muscle injury, and trapped tissue can each contribute.
Restricted movement
The eye may not move normally or may hurt with movement. This needs assessment rather than assuming it is only swelling.
A sunken or lower eye
Loss of support can change where the eye sits. This may become more noticeable as swelling decreases.
Cheek or upper-lip numbness
A nerve running along the orbital floor may be bruised or injured. Repair does not guarantee that normal feeling will return.
03 · Options
How the approaches differ
The treatment plan depends on the fracture pattern, eye examination, symptoms, and timing. These approaches may be combined rather than offered as interchangeable choices.
Observation with reassessment
Allow swelling to settle while checking eye function and position.
How it worksThe team schedules follow-up examinations and gives injury-specific precautions.
May suitSelected fractures without urgent entrapment or significant functional or position problems.
Main tradeoffSymptoms or eye position may change, making later repair necessary.
Release of trapped tissue
Free tissue caught in the fracture.
How it worksThe surgeon carefully lifts tissue back into the socket and checks movement.
May suitConfirmed or strongly suspected entrapment, sometimes requiring urgent surgery.
Main tradeoffMuscle injury may still cause double vision after the tissue is released.
Orbital floor reconstruction
Rebuild support beneath the eye.
How it worksAn implant or selected graft bridges the defect after displaced tissue is repositioned.
May suitFractures with inadequate support, significant displacement, or ongoing symptoms that warrant repair.
Main tradeoffImplant-related problems, persistent symptoms, or further surgery are possible.
Combined facial fracture repair
Treat the orbital floor along with nearby broken bones.
How it worksThe team restores surrounding bone position and reconstructs the floor as needed.
May suitInjuries involving the cheekbone, orbital rim, or other facial structures.
Main tradeoffA more extensive injury can mean a longer operation and a more involved recovery.
A surgeon experienced in orbital trauma should explain why observation or repair fits your examination and imaging findings. [1] [2].
Where is the incision?
Access is often through the inside of the lower eyelid; some injuries require an incision below the eyelashes or another approach. Ask how the planned incision may affect scarring and lower-eyelid position.
Will an implant need to be removed?
Many implants are intended to remain in place. The choice depends on the defect and surgeon's judgment. Infection, exposure, or a position problem can occasionally lead to revision or removal.
04 · Results
What may improve and what may remain
Eye movement and double vision
Repair may improve movement, but double vision can persist.
- Swelling and muscle injury can delay improvement.
- Some people need additional treatment even after the bone support is restored.
Eye position and support
The goal is a better-supported, more balanced eye position.
- Final position becomes easier to assess as swelling settles.
- Severe injury or scarring can limit symmetry.
Feeling and longer-term recovery
Nerve recovery is less predictable than rebuilding bone support.
- Cheek, upper-lip, or upper-tooth numbness may improve gradually or remain.
- Repair cannot reverse every injury to the eye, muscle, or nerve.
Recovery depends on the original injury as well as the repair. Follow-up eye examinations help track function, position, and persistent symptoms. [1]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Your surgical and eye-care teams will tailor recovery guidance to your injury and repair. Returning to work does not mean the socket has fully healed.
Step 1 · Day of surgery
Treatment day
The team checks vision, eye movement, pain, and swelling after anesthesia. Discharge timing depends on the injury, procedure, and need for monitoring.
Step 2 · First several days
Early recovery
Bruising, swelling, soreness, and temporary changes in eye movement may occur. Follow your team's eye-care and medication plan. Ask your surgical team whether compresses are appropriate and exactly how to use them.
Step 3 · Following weeks
Follow-up and gradual activity
Examinations track vision, wound healing, and eye position. Your team decides when work, lifting, and exercise are appropriate.
Step 4 · Weeks to months
Longer-term assessment
Swelling and sensation may continue to change. Persistent double vision or a change in eye position may need further assessment or treatment.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Work and screensPlanning context: Depends on vision, comfort, and job demandsWhat affects it: Double vision, eye strain, and physically demanding work may delay return.
DrivingPlanning context: Only when vision and medication effects allow safe drivingWhat affects it: Double vision, reduced vision, or sedating medicine can make driving unsafe; obtain clearance.
Nose blowing and pressure changesPlanning context: Ask for specific restrictions and duration [1]What affects it: Nose blowing can force air from the sinus into the injured socket. Ask before flying or diving.
Exercise and contact sportsPlanning context: Resume in stages with clearance [2]What affects it: Straining and another blow to the face can threaten recovery; protection and timing depend on the repair.
Use your surgical team's written restrictions rather than a general recovery calendar.
Before your procedure
- Bring available CT images, reports, and records of prior eye treatment.
- Describe vision changes, nausea, pain with movement, and any facial numbness.
- Review medicines, supplements, allergies, and bleeding history with the team.
- Ask which medicines need adjustment; do not stop prescribed medicines on your own.
- Discuss nicotine use and health conditions that may affect healing or anesthesia.
- Arrange transportation, support after anesthesia, and access to follow-up care.
Is double vision after surgery always a sign of failure?
No. Swelling and injured muscles can affect alignment during recovery. However, new or worsening double vision should be reported promptly, especially with pain or reduced vision.
Will I need antibiotics or eye drops?
That depends on the injury, surgical approach, and examination. Use only the medicines and eye products your treating team recommends.
06 · Safety
Risks and what your clinician assesses
Bruising, swelling, soreness, temporary blurred or double vision, and altered cheek sensation can occur. New or worsening symptoms should not automatically be treated as normal recovery.
Bleeding behind the eye
Pressure from bleeding can threaten sight and may require emergency treatment.
Infection
Infection can involve the wound, sinus, or implant and may require medication or another procedure.
Persistent double vision
Muscle injury, scarring, or alignment changes may leave ongoing movement problems.
Vision injury
Damage to the eye or optic nerve can cause lasting vision loss, including blindness.
Position or implant problems
The eye may remain sunken or uneven. An implant may shift or need revision.
Eyelid, nerve, and anesthesia complications
Possible problems include lower-eyelid pulling, scarring, persistent numbness, and reactions or other complications related to anesthesia.
Discuss these risks and your individual health history with your surgeon. [2]
What your clinician assesses
- Vision, pupils, eye movement, and signs of injury inside the eye
- Fracture size and location, displaced tissue, and possible entrapment on CT
- Eye position, facial sensation, and associated facial fractures
- Medical conditions, medicines, nicotine use, and anesthesia risks
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope, including whether care involves only the orbital floor or other facial fractures. Insurance coverage and out-of-pocket costs depend on your plan, providers, and treatment setting.
Surgeon
Surgical care
Surgeon's care and the planned fracture repair.
Ask your surgeonAsk whether additional fracture repairs, implants, or another specialist are billed separately.
Facility
Anesthesia and facility
Anesthesia services, operating room use, and recovery monitoring.
Ask your surgeonAsk about separate bills and possible hospital admission charges.
Supplies
Supplies and follow-up
Prescribed supplies, medicines, imaging, and follow-up visits as listed.
Ask your surgeonConfirm what is included and how additional testing or revision care is handled.
TRC
Patient Services
Any separately listed coordination or administrative services.
Ask TRCAsk whether these services apply, what they include, and whether they are optional.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Is this the same as eyelid surgery?
No. Orbital floor repair treats the bony socket beneath the eye. An eyelid incision may provide access, but the purpose is not cosmetic removal of eyelid skin or fat.
Can a small fracture still be serious?
Yes. A small fracture can trap tissue, particularly in children. Symptoms and examination matter alongside fracture size.
Will my cheek numbness go away?
It may improve as the injured nerve recovers, but numbness can persist. Repair does not guarantee restored feeling.
Who manages this injury?
Care may involve an ophthalmologist and a surgeon trained in orbital and facial trauma, such as an oculoplastic, plastic, or maxillofacial surgeon. The team depends on the injuries involved.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Understand the urgency, treatment goal, and limits of repair.
- Have a written recovery plan, follow-up schedule, and emergency contact route.
- Review the planned scope, insurance arrangements, and written estimate.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]Cleveland Clinic: Orbital FracturesOrbital fracture anatomy, symptoms, eye examination and CT assessment, observation versus surgery, entrapment, nose-blowing precautions, and urgent vision-related symptoms.
- [2]American Society of Plastic Surgeons: Facial FracturesIndividualized facial fracture repair, associated facial injuries, surgical risks including eye and nerve injury, and activity restrictions during recovery.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.