Orbital fractures in sport: a review

Orbital fractures represent a small proportion of sports-related injuries in the US and abroad. However, the significant functional and cosmetic sequelae of such fractures warrant a comprehensive evaluation of any athlete sustaining facial trauma. Initial evaluation is directed at excluding neurological impairment or the presence of vision-threatening injury. Subsequent examination should ascertain the presence of signs and symptoms consistent with orbital fracture. These include gross bony deformity, limitation of gaze, diplopia and malposition of the globe. The presence of any of the aforementioned symptoms should prompt further investigation using computed tomography to corroborate or refute clinical suspicion. Orbital fracture mandates referral to an ophthalmologist or oculoplastic surgeon; initial management is dictated by the severity of functional symptoms, and may necessitate early surgical intervention. Those patients who are managed conservatively should return for frequent follow-up, as progressive diplopia, enophthalmos, or gaze limitation are indications for late operative repair. The majority of patients who sustain orbital fractures are able to return to sport, however, persistent diplopia is not uncommon, and may persist despite optimal treatment.