Recognition and management of an orbital blowout fracture in an amateur boxer

STUDY DESIGN: Case report. OBJECTIVES: To identify key elements in the recognition and management of a patient with an orbital blowout fracture and make recommendations on diagnosis, treatment, referral, imaging, and return to sports. BACKGROUND: Orbital blowout fractures are uncommon but important injuries for physical therapists to recognize. Immediate management is essential in preventing complications. The mechanism of injury is a direct blow to the orbital rim or orbit. CASE DESCRIPTION: The patient reported to the athletic training room 15 minutes after completing a boxing match and reported that his left eye had suddenly inflated after blowing his nose. We suspected an orbital blowout fracture and referred him immediately to the emergency department where conventional radiographs were ordered. On follow-up the next day, after determining that the radiographs were normal, but still having a high index of suspicion for an orbital blowout fracture, we referred him to his primary care manager. The primary care manager ordered a computed tomography scan that revealed the fracture and referred the patient to ophthalmology. OUTCOMES: The patient was restricted from the remaining 4 weeks of the boxing season. He completed a rigorous Army physical fitness test 7 days postinjury and the Marine Corps Marathon 47 days postinjury. DISCUSSION: Orbital blowout fractures without double vision, extraocular muscle entrapment, or persistent numbness can be treated with time and protection. The patient can continue with normal fitness activities except contact or collision sports.