What precautions should a patient take after an orbital blowout fracture?

Patient Precautions After Orbital Blowout Fracture

Patients must avoid nose blowing, sneezing with an open mouth, and contact sports to prevent orbital emphysema, secondary displacement, and further injury during the critical healing period. 1

Critical Immediate Precautions

Avoid Activities That Increase Orbital Pressure

• Never blow your nose for at least 2-4 weeks after the injury, as this can force air from the sinuses into the orbital tissues, causing sudden orbital swelling and potentially worsening muscle entrapment 2
• Sneeze with your mouth open to avoid increasing pressure in the sinuses that communicates with the fractured orbit 2
• Avoid straining during bowel movements, heavy lifting, or Valsalva maneuvers that increase intraorbital pressure 1

Activity Restrictions Based on Treatment Plan

• Complete restriction from contact or collision sports is mandatory during the initial healing period, typically 4-7 weeks depending on fracture severity 2
• Non-contact cardiovascular exercise (running, cycling) can typically resume within 1 week if no surgery is planned and symptoms are minimal 2
• If surgical repair is performed, expect overnight observation or longer due to the risk of retrobulbar hematoma, which occurs in approximately 1.3% of cases and requires emergency intervention to prevent permanent vision loss 3

Monitoring for Urgent Complications

Watch for Vision-Threatening Signs

• Seek immediate emergency care if you develop sudden vision loss, severe eye pain, progressive swelling, or new double vision, as these may indicate retrobulbar hematoma requiring urgent surgical decompression 1, 3
• Monitor for signs of oculocardiac reflex including bradycardia, dizziness, nausea, vomiting, or loss of consciousness, which indicate muscle entrapment requiring urgent surgical intervention 1
• Report progressive numbness in the cheek or upper lip (infraorbital nerve territory), as worsening hypoesthesia may indicate need for earlier surgical repair within 2 weeks 4, 5

Symptom Management During Observation Period

Conservative Treatments for Diplopia

• Expect a 4-6 month observation period before considering strabismus surgery, as many cases of double vision resolve spontaneously during this time 4, 1
• Use eye occlusion (patching) for temporary diplopia relief during daily activities 1
• Fresnel prisms or prism glasses can provide temporary or permanent relief of double vision without surgery 4, 1
• A short course of oral steroids may be prescribed to hasten recovery of orbital swelling and reveal whether persistent strabismus will remain 4

Setting Realistic Expectations

• Understand that even with proper surgical repair, 37% of patients have persistent diplopia postoperatively, so complete resolution cannot be guaranteed 4, 1
• Serious ocular injury occurs in 24% of blowout fractures, and complete vision loss occurs in 5.5% of patients in one eye, emphasizing the importance of close ophthalmologic follow-up 4, 1
• Multiple surgeries and long-term use of prism glasses may be required to manage residual symptoms 4

Follow-Up Care Requirements

Multidisciplinary Monitoring

• Maintain close follow-up with ophthalmology for assessment of extraocular muscle function, forced duction testing, and monitoring for enophthalmos (sunken eye appearance) 4, 1
• Early surgical repair within 2 weeks significantly reduces the risk of persistent diplopia, enophthalmos, and infraorbital nerve dysfunction compared to delayed repair 5
• If you develop persistent restrictive strabismus or unresolved enophthalmos after the 4-6 month observation period, delayed surgical repair may still provide benefit 4

Common Pitfalls to Avoid

• Do not assume normal X-rays rule out a fracture—CT imaging is required for definitive diagnosis, as conventional radiographs can miss orbital fractures 2
• Do not delay seeking care if symptoms worsen, as the timing of surgical intervention is critical: immediate repair for muscle entrapment with oculocardiac reflex, repair within 2 weeks for symptomatic diplopia with CT evidence of entrapment, or observation for minimal symptoms 4, 1
• Fat entrapment can be nearly as problematic as muscle entrapment, causing fibrotic adhesions that are difficult to repair surgically, so early appropriate management is essential 4, 1