RICE & MICE: Orbital Fractures

Sometimes it seems that injuries have an ebb and flow to them and that certain injuries that are more common one year are not necessarily as common the next. One of the reoccurring themes on the IR lists of many teams this year seems to have been facial fractures. More severe than the run-of-the-mill broken nose, facial fractures can cause serious trouble. Some fractures of the orbit can pose a risk to normal eye function and require surgical repair and thus, a more lengthy recovery.

The orbit isn’t a bone, rather it’s comprised of the seven bones that house the eyeball and provides protection for the eye. Fractures of the orbit can occur in any of these bones. Think of it as a house for the eye, there are 2 walls, a roof and a floor. The most common area that is fractured is the orbital floor, also referred to as a blowout fracture.

Orbital floor fractures are a result of blunt trauma, when an object such as a hard, frozen rubber puck, hits the orbit, the force is transmitted to the bones, which sometimes causes the bones to break.

There is usually fairly immediate swelling accompanied by bruising, tenderness, bleeding in the white of the eye (also called a subconjunctival hemorrhage) and sometimes there is numbness of the cheek, nose or teeth, double vision and nose bleeds. When the floor of the orbit buckles it can trap the muscles that move the eye and cause pain when attempting to move the eye or inability to move the eye in a certain direction.

Usually an x-ray or CT scan will be performed if there is suspicion of a fracture. A simple fracture will have minimal or no double vision, small fracture and little to no interference with eye movement. Simple fractures usually heal on their own with rest and ice. More complex fractures may require surgical repair, especially if the fracture is large or extensive, if double vision is severe or the eye has a “sunken” appearance.

Visual acuity is one of the important things to consider with orbital fractures. The magic number for visual acuity is 20/40 and especially in hockey players, the bone needs protection while healing, so a full face shield is usually worn by players coming back from an orbital fracture. As soon as the athlete feels comfortable in practicing and playing they are released to return to play.

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