Orbit

Postoperative (and post injury) problems affecting the orbit (eye socket) include

Loss of vision. Clearly this is extremely rare but devastating. Conditions which raise the pressure inside the enclosed space of the eye socket which contains the globe of the eye, its nerve and blood vessels, and surrounding fat and connective tissue, can create a risk to sight. These include bleeding (particularly arterial bleeding) and infection but may even include air at higher than normal pressure. Orbital compartment syndrome (condition arising from increased pressure in the orbital space) is one of a small number of genuine maxillofacial emergencies.
Disturbance of vision. The muscle attachments for the muscles that move the globe of the eye are attached at various points in the orbit. Eye movement is dependent on these muscles and the position of the globe of the eye sitting in a surrounding of peri-orbital fat, given support by fibrous strands of fascia (a form of connective tissue). Change in the position of the globe of the eye or disturbance of the function of the relevant muscles leads to double vision.
Disturbance in sensation. The nerve supplying feeling to the area of cheek below the eye runs in the floor of the orbit. This is a typical area for fractures as it is so thin. Cheekbone (zygoma or malar) complex fractures often include an element of disruption of the orbital floor. Less often the medial wall and much less often the roof or lateral wall are affected. Altered sensation in this area is common after injury of soft and hard tissue or surgery.
Appearance. Bruising and black eyes are common after both injury and surgery. More specific is the ‘subconjunctival haemorrhage’ (bleeding underneath the conjunctiva (the membrane that covers the white of the eye and lines the inside of the eyelids)) which is a bright red complete colouring out of either the lateral conjunctiva (to the side; cheekbone fracture) or medial (to the middle; serious nasal fracture). Chemosis is swelling of the conjunctiva which can look dramatic but is harmless and settles quickly. Surgical scars are very cosmetic and rarely seen. Rarely if an eyelid is operated on when swollen, the lower lid can retract outwards (ectropion) or inwards (entropion).
Pain and nausea. Occurs rarely and usually in the young. Pain, nausea and vomiting can occur in a condition called ‘white eye blow out’ which is a pure pressure induced fracture of the orbital floor. It is an indication for early surgery diagnosed by coronal CT scans or ultrasound imaging of the orbit.