What Happens If Orbital Bone Isn'T Treated??

What Are The Main Functional Consequences Of Untreated Fractures?

One of the most common and persistent functional consequences of an untreated orbital fracture is chronic double vision (diplopia). This occurs when the fracture site traps or restricts the movement of one or more of the extraocular muscles (such as the inferior rectus muscle) and surrounding soft tissue. When the muscle is restricted, the affected eye can't move in coordination with the unaffected eye, causing the brain to receive conflicting visual signals, which is perceived as persistent double vision.

Another serious functional consequence is sensory loss or numbness. The infraorbital nerve, which provides feeling to the lower eyelid, cheek, upper lip, and upper teeth, runs directly through the area of the orbital floor. An untreated fracture can damage or compress this nerve, leading to persistent hypoesthesia (decreased sensation) or paresthesia (a tingling or prickling sensation) in the distribution of the nerve, which can be long-lasting.

What Are The Long-Term Aesthetic And Structural Complications?

The most noticeable long-term aesthetic complication is enophthalmos, which is the posterior displacement or sinking of the eyeball deeper into the socket. This happens when the fracture defect is large, causing orbital contents (like fat and muscle) to prolapse into the sinus cavity and increasing the volume of the eye socket. As swelling subsides over several weeks, the resulting recession of the eyeball can cause significant facial asymmetry and a sunken appearance of the affected eye.

In some cases, the disruption to the orbital floor or rim can lead to dystopia, where the eyeball is positioned lower than the unaffected eye (hypoglobus). If the orbital rim fracture is complex, improper healing can result in a palpable step deformity or an abnormally flattened cheek, which permanently alters the smooth contour of the facial bones and requires reconstructive surgery to correct.

What Happens To The Muscles And Nerves?

If the extraocular muscles, especially the inferior rectus or inferior oblique muscles, remain incarcerated or entrapped in the fracture site for too long, they can suffer ischemia (lack of blood supply) and fibrosis (scarring). This muscular damage may become irreversible, leading to permanent restriction of eye movement and chronic diplopia that may not be fully correctable even with delayed surgery.

Although less common, an untreated fracture involving the optic canal or a large retrobulbar hematoma (bleeding behind the eye) that causes severe proptosis (bulging) can lead to optic nerve compression. This is a true ophthalmic emergency, and if the pressure isn't relieved promptly, it can cause irreversible damage to the optic nerve fibers, resulting in partial or total permanent vision loss in the affected eye.

What To Remember About Untreated Orbital Bone Fractures

Untreated orbital bone fractures carry a high risk of long-term complications, such as chronic double vision (diplopia) due to muscle restriction and enophthalmos (a sunken eyeball) due to loss of bone support.

Early diagnosis and appropriate treatment, ranging from close observation to surgical reconstruction, restore proper eye function, prevent permanent vision loss, and maintain the aesthetic balance of the face.

References

American Academy of Ophthalmology (AAO). What Is an Orbital Fracture?

Barraquer. Impact of orbital fracture on the eye.

National Institutes of Health (NIH), PMC. Ophthalmologic Findings in Patients with Non-Surgically Treated Blowout Fractures.

University of Miami Health System. Orbital Facial Fractures.

In Focus Ophthalmic Plastic Surgery. What Happens if an Orbital Fracture Goes Untreated?