Eye and eye socket injuries occur fairly commonly. Injuries include eyelid laceration, canalicular laceration (tear drain injuries), orbital hemorrhage (bleeding), and orbital fractures (eye socket bone fractures, “blow-out fracture” with enophthalmos or true sunken eye). They can result from blunt eye trauma or sharp injuries, including many sport-related activities, falls, assaults, etc. The eyeball itself is also prone to injury and it too needs to be thoroughly.
Orbital blow-out Fracture Surgery
An “orbital blow out fracture” results from trauma to the orbit and eye area with resultant force causing fracture of the orbit into the adjacent sinuses as the orbital bones are fragile and thin. The most common location of the fracture is the orbital floor followed by the medial wall. Not all orbital (blow out) fractures need to be surgically fixed. Criteria for orbital “blow out” fracture surgery include large fractures, diplopia (double vision), and enophthalmos (sunken eyes). Orbital “blow out” fracture repair should be performed within the first 2 weeks of the trauma. Waiting longer can result in scarring and increased difficulty in the repair with lowered success rate. However, at times the surgeon is forced to address the problem later on for various reasons. For instance, sunken eyes from the orbital fracture can manifest or worsen later on. In those cases, surgery is performed later to improve sunken eyes (enophthalmos surgery).
Dr. Taban uses the latest minimally invasive technique to repair orbital fractures and has even penned an article about Orbital Wall Fracture Repair Using Seprafilm.
During your consultation with Dr. Taban in Beverly Hills/Los Angeles or Santa Barbara, he will evaluate your eyes and face and review orbital CT scan to assess the severity of the orbital fracture and need for orbital fracture surgery repair. Dr. Taban performs orbital fracture surgery using hidden incision inside the eyelids, with quick recovery. Orbital blow out fracture surgery is performed under general anesthesia, which usually takes about an hour to complete. As an outpatient procedure, the patient goes home after surgery and follows up in clinic a week later. Enophthalmos surgery is done similarly to orbital fracture surgery, requiring an orbital implant. Sometimes, enophthalmos or sunken eyes can be helped with filler injection in the orbit or eyelid, in the office.
Severe Eye Trauma
Severe eye trauma that causes irreparable eye injury may require eye removal (evisceration or enucleation). Other reasons for eye removal include eye tumors and blind/painnful eyes. Reconstruction of the eye socket to prepare it for a prosthetic eye typically leads to a very pleasing result in addition to the benefits of removing the blinded eye or diseased, painful eye.
Eyelid Laceration and Canalicular Laceration
Eyelid laceration from blunt or sharp trauma is common. Some involve the skin only, while others involve deeper eyelid structures. The canaliculi are the proximal portion of the tear duct drainage system that are located in the eyelids themselves, close to the nose. Trauma can cause laceration or avulsion of the canaliculus. They need to be repaired within 48 hours in order to preserve the tear duct system and avoid irreparable damage.
It is important for someone familiar with the eyelid anatomy to repair these lacerations. The eyelid is made up of many layers and each layer needs to be reconstructed accordingly for best aesthetic and functional outcome.
Before (left photo) and 3 months after (right photo) of a 40 year old female who underwent right eye sunken eye (enophthalmos) surgery. Note that the right eyeball is lower (termed hypoglobus) in the before photo and then in normal symmetric position in the after photo. She would also benefit from filler injection on both sides.
Left photo shows right orbital blow out fracture with inability to move the eye up. Right photo is 6 weeks after orbital fracture surgery with eye movement restored.
Before (left) and after (right) of an eyelid laceration.
Before (left) and after (right) sunken eye surgery (enophthalmos surgery) with right orbital implant placement.
Before (left) 40 year old male, with history of multiple large orbital fractures, with significant enophthalmos (sunken eye) and cheek fracture with sunken cheek. After (right) 4 months after right orbital fracture surgery, enophthalmos (sunken eye) surgery with orbital floor implant, and cheek implant.
Who Should Treat Orbital and Eyelid Trauma?
The orbit is a small, compact and complex structure. The eyelid is also a mobile, complicated structure, made up of many different layers. Oculoplastic surgeons have undertaken the extra training to deal with the nuances of treating orbital and eyelid diseases and injuries. An oculoplastic surgeon, who is a member of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), is someone who is a board certified ophthalmologist who has completed additional 2-year fellowship training in cosmetic and reconstructive plastic surgery of the eyelids, orbits (eye socket), lacrimal system( tearing system) and surrounding structures. Dr. Taban is double board certified by American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), American Academy of Ophthalmology (AAO), and a diplomat of the American Board of Cosmetic Surgery (ABCS).
Dr. Mehryar (Ray) Taban is a board certified ocular-plastic surgeon in Beverly Hills, Los Angeles and Santa Barbara with extensive knowledge in the treatment of orbital fractures and eyelid Trauma. To learn more about the different treatment options that may be suitable for you, contact Dr. Taban today to schedule an initial consultation.