Eye Socket (Orbital) Fracture Repair in NYC

The eye socket is one of the most delicate regions of the face — formed by thin, fragile bones that protect the eye while also providing its structural support. When these bones fracture, the consequences extend well beyond the visible injury to affect eye position, eye movement, and vision itself. Orbital fractures most commonly result from blunt trauma — auto accidents, falls, sports injuries, and physical assault — where the eye socket bones, particularly the thin floor and walls, are unable to withstand the impact. Whether the injury comes from a baseball striking the face, a car accident, or a fall, these fractures require expert repair using current advances in reconstructive surgery. Unlike fractures elsewhere on the face, orbital fractures carry the additional concern of affecting the eye and its function — even when the eye itself is not directly damaged in the original injury.

The eye socket is one of the most delicate regions of the face — thin bones that simultaneously protect the eye and provide its structural support, where fractures affect not just facial appearance but eye position, eye movement, and vision itself. Dr. Maurice Khosh’s three decades of orbital reconstruction draw on the head-and-neck surgical foundation that this anatomy demands. Dual board-certified — including by the American Board of Otolaryngology–Head and Neck Surgery, the specialty most directly concerned with orbital anatomy — Dr. Khosh holds active hospital privileges at NewYork-Presbyterian, Mount Sinai West, the Manhattan Eye, Ear, and Throat Infirmary (MEETH), and Lenox Hill Hospital. A Fellow of the American College of Surgeons (FACS), he has been recognized as a perennial Castle Connolly Top Doctor.

How Eye Socket Fractures Affect Vision and Eye Function

An orbital fracture can produce several distinct functional problems, even when the eye itself is not directly injured:

• Double Vision (Diplopia): When the eye muscles or surrounding tissue become entrapped by fracture fragments, the eye loses its ability to move normally — typically most noticeable when looking upward
• Sunken Eye Appearance (Enophthalmos): A displaced orbital floor or wall causes the eye to sit deeper in the socket, producing a sunken appearance
• Eye Position Drop: The eye may drop downward when the orbital floor loses its support, producing visible asymmetry between the two eyes
• Restricted Eye Movement: Inability to look in certain directions due to muscle entrapment or scar tissue
• Cheek and Upper Lip Numbness: The infraorbital nerve runs along the floor of the eye socket; fractures often produce numbness across the cheek, side of the nose, and upper teeth
• Eyelid Movement Difficulty: Difficulty opening or closing the eyelid due to changes in surrounding anatomy
• Visible Facial Asymmetry: Even subtle orbital displacement can produce noticeable facial asymmetry compared to the unaffected side

Common Causes of Orbital Fractures

Most orbital fractures result from significant blunt trauma to the eye region:

• Motor Vehicle Accidents: Impact with the steering wheel, dashboard, or airbag during car accidents
• Sports Injuries: Direct blows to the eye region in contact sports (baseball, basketball, soccer, hockey, martial arts)
• Falls: Particularly falls in elderly patients or onto sharp or uneven surfaces
• Physical Assault: The eye socket is a common impact site in physical altercations
• Workplace and Industrial Accidents: Industrial impact injuries or falling objects
• Pedestrian and Cycling Accidents: Direct trauma to the face during impact

What Is a Blowout Fracture?

The most common type of orbital fracture is called a blowout fracture — and the name describes the mechanism. When significant force is applied to the eye itself, the increased pressure inside the orbit causes the floor of the eye socket — the thinnest of the orbital walls — to “blow out” downward into the underlying maxillary sinus. The eye itself often escapes major injury because the floor breaks first, absorbing the force, but the broken floor then cannot support the eye properly.

Characteristics of blowout fractures:

• Eye Often Spared: The fracture mechanism itself often protects the eye from direct damage
• Floor Most Commonly Affected: The orbital floor is the thinnest wall and the most frequent fracture site
• Medial Wall Fractures Common Too: The thin medial wall (between the eye socket and the nasal sinuses) is another frequent fracture location
• Trapped Tissue Concern: Soft tissue or eye muscles can become trapped in the fracture defect, which is what produces double vision and restricted eye movement
• Subtle Initial Presentation: Blowout fractures may not be immediately obvious externally — the eye looks normal, but the patient reports double vision or has difficulty looking upward

When Orbital Fracture Repair Is Necessary

Not every orbital fracture requires surgical repair. Surgical intervention is typically indicated when one or more of the following findings are present:

• Persistent Double Vision: Diplopia lasting more than one to two weeks after the injury, indicating likely muscle entrapment
• Significant Eye Position Change: Visible enophthalmos (sunken eye) or hypoglobus (downward eye displacement) on examination
• Large Defect on Imaging: CT scan findings of a substantial orbital floor defect that is unlikely to heal adequately without support
• Entrapped Eye Muscles: Clinical or imaging findings of inferior rectus or other muscle entrapment in the fracture
• Restricted Eye Movement: Inability to move the eye in certain directions due to muscle entrapment
• Cosmetic Asymmetry Concern: Patient concern about visible facial or eye-position asymmetry

For small, non-displaced fractures without functional consequences, conservative management with close monitoring may be appropriate.

How Eye Socket Fracture Repair Surgery Works

Orbital fracture repair involves accessing the eye socket through carefully placed incisions, freeing any entrapped tissue, and reconstructing the fractured floor or wall with an implant that restores proper anatomical support:

• Incision Through the Lower Eyelid: A small incision placed just below the lashes of the lower eyelid (the subciliary approach) or just inside the lower eyelid (the transconjunctival approach) provides access to the orbital floor while leaving no visible facial scar
• Soft Tissue Release: Any entrapped fat, muscle, or other soft tissue is carefully freed from the fracture defect
• Defect Reconstruction: The fracture is patched with a thin sheet of biocompatible material — typically a titanium mesh, porous polyethylene, or absorbable plate — that supports the eye in its proper anatomical position
• Restoration of Orbital Volume: The implant precisely fills the bony defect to restore normal eye position and prevent enophthalmos
• General Anesthesia: The procedure is performed under general anesthesia at an accredited surgical facility, typically as an outpatient procedure

“Orbital fracture repair is one of the procedures where the surgical work is done within a very small space, within millimeters of the eye, and where the smallest decisions can affect both vision and appearance. The most important variable is timing — entrapped muscles need to be released within two weeks, ideally sooner, to preserve eye movement. After that window, the muscle can develop permanent scarring that surgery cannot fully correct. We tell every orbital fracture patient the same thing: the sooner we evaluate, the better the options.” — Dr. Maurice Khosh

Coordination with Ophthalmology

Comprehensive orbital fracture care requires close coordination with ophthalmology for several reasons:

• Pre-Surgical Eye Examination: A thorough ophthalmologic examination is essential before orbital surgery to identify any direct eye injury that may need separate treatment
• Visual Field Testing: Some patients require formal visual field assessment to document any pre-surgical visual disturbance
• Post-Operative Monitoring: Ongoing monitoring of eye position, eye movement, and vision in the weeks following surgery
• Long-Term Follow-up: Some patients may need ongoing ophthalmologic care for residual functional changes

Dr. Khosh works closely with ophthalmologists at MEETH and other NYC hospitals to provide this coordinated care for orbital fracture patients.

Orbital Fracture Repair Recovery

Orbital fracture repair surgery typically takes one to two hours depending on the complexity of the fracture and the implant material used. Patients return home the same day. Bruising and swelling around the eye are most pronounced during the first one to two weeks, with significant resolution over the following four to six weeks. Most patients return to non-physical work within ten to fourteen days. Double vision typically improves substantially within the first weeks following repair as the released muscles regain their normal function, though some patients may need vision therapy or ongoing ophthalmologic care. Numbness in the cheek, side of the nose, and upper teeth (from the infraorbital nerve) usually improves over three to six months as the nerve recovers.

Why Choose Dr. Khosh for Eye Socket Fracture Repair

• Head-and-Neck Surgical Foundation: Board certification specifically in the anatomy of the head and neck, including the orbital region
• Hospital Privileges Including MEETH: Active privileges at the Manhattan Eye, Ear, and Throat Infirmary — the NYC hospital most identified with eye-related surgical care
• Three Decades of Orbital Reconstruction: Refined experience across the spectrum of orbital fracture patterns
• Hidden Incision Technique: Surgical access through the lower eyelid or transconjunctival approach to leave no visible facial scarring
• Coordinated Ophthalmology Care: Established working relationships with ophthalmologists for comprehensive eye-related surgical care
• Functional and Aesthetic Integration: Repair planned to address visual function, eye position, and facial appearance simultaneously
• Dual Board Certification: Combined facial plastic and head and neck surgery expertise

Schedule Your Eye Socket Fracture Consultation in NYC

Eye socket and orbital fracture repairs are complex and require precise surgical expertise. If you have suffered an eye socket fracture — particularly if you are experiencing double vision, restricted eye movement, or visible changes in eye position — early evaluation makes a significant difference in surgical outcomes. To schedule a private consultation with Dr. Khosh at his Park Avenue office in New York City, contact our office today, or call (212) 339-9988.