About a year ago, a 36-year-old woman entered London’s North Middlesex University Hospital experiencing all of the telltale signs of a fist-fight. She was bleeding from the nose, complaining of vision loss and experiencing swelling and extreme pain on the left side of her face, according to a recent case report published in The BMJ. Her symptoms all pointed to an eye socket fracture—what’s called an orbital blowout fracture, an injury typically sustained from punches or other facial trauma.
But all this woman had done was blow her nose.
“It’s very bizarre. We see eye socket fractures from people in trauma, people getting punched, people in a fight,” says Dr. Sam Myers, an upper gastrointestinal tract doctor who treated the woman, and co-author of the BMJ paper. “I’ve never, ever heard of it ever happening from someone blowing their nose. Everyone blows their nose. They don’t think they can blow out their eye.”
It’s fairly easy to fracture some small facial bones, but it’s “very rare” such a thing would happen from blowing your nose, says Myers. It’s not entirely clear why the woman got so unlucky—she told doctors she hadn’t blown her nose exceptionally hard, and she was otherwise healthy—but Myers speculates that she “must have had a predisposition or a weakening in the skeletal area around the eye” that simply gave way. The woman also smoked about 20 cigarettes a day, which Myers says may have played a part.
“If you close the other nostril and then blow, sometimes that pressure can be quite a lot,” Myers says. “But for the amount of pressure from her blowing her nose to be equal to a punch, that’s quite incredible.”
Still, the woman’s case turned out to be relatively simple to treat: The fracture was clean, her vision wasn’t permanently affected and she did not require surgery. Doctors sent her on her way with painkillers and directions to temporarily avoid blowing her nose or playing contact sports, and to cut back on smoking. She has recovered well in the year since the accident, though she reported a lingering side effect: daily pain on the left side of her face lasting anywhere from 30 minutes to a few hours.
Myers emphasizes that the average nose-blower is likely not at risk of an orbital blowout, and says there are few preventive measures that people can or should take, aside from avoiding “excessive” or aggressive nose-blowing.
Still, “I’ve blown my nose a bit less since then,” Myers says.