Not all orbital fractures require surgery. Rabinowitz said surgery is needed if a patient has persistent double vision. Some may also have nausea or even heart symptoms. Sometimes muscles get caught in fractures. This is more common in children, who have flexible bones, than in adults. If there is concern that the eye will sink, surgery is also a good idea. Because of the demands of the job, an elite athlete may be more likely than the average person to choose surgery. The same might be true for a pilot.