Return to Sport After Orbital Fracture and Face Mask Recommendations
A protective face mask is strongly recommended for athletes returning to soccer after an orbital fracture, with return to play possible as early as 3 weeks post-injury for professional athletes, though this should be delayed until at least 24 days after surgical repair to ensure adequate healing. 1, 2
Assessment and Initial Management of Orbital Fractures
Immediate Evaluation
- Comprehensive imaging is essential - CT scan is the gold standard with 94.9% sensitivity for detecting fractures 3
- Assess for:
- Entrapped muscles or periorbital tissue
- Oculocardiac reflex (bradycardia, dizziness, nausea)
- Diplopia (double vision)
- Visual acuity changes
- Restricted eye movement
- Enophthalmos or hypoglobus
Surgical Indications and Timing
Surgical repair timing depends on specific findings 4:
Immediate repair required for:
- Entrapped muscle with oculocardiac reflex
- White-eyed blow-out fracture with muscle entrapment
- Globe subluxation into maxillary sinus
Repair within 2 weeks for:
- Symptomatic diplopia with positive forced ductions
- Large floor fractures
- Early enophthalmos causing facial asymmetry
- Progressive infraorbital hypoesthesia
Delayed repair (after 2 weeks) for:
- Restrictive strabismus and unresolved enophthalmos
Return to Soccer Protocol
Timeline for Return to Play
Minimum healing period: 24 days (3-4 weeks) is when orbital floor strength is regained after repair 2
- This is significantly earlier than the conventional 8-12 weeks previously recommended
Professional athletes with proper protection:
Amateur athletes:
- More conservative approach recommended
- Avoid contact sports for at least 3-4 weeks after uncomplicated repair
- Resume non-contact fitness activities immediately if asymptomatic 6
Protective Face Mask Requirements
- Mandatory for early return to soccer (before 6 weeks) 1
- Custom-fitted face mask provides protection against:
- Direct blows to the orbital rim
- Ball impact to the face
- Incidental contact with other players
Stepwise Return to Activity
Initial recovery phase (0-10 days):
- Light aerobic exercise (walking, stationary cycling)
- Avoid heading, facial contact, and diving
- Monitor for diplopia or visual symptoms
Intermediate phase (10-24 days):
- Sport-specific training without contact
- Running, ball skills (no heading)
- Fitting and adaptation to protective face mask
Return to contact (after 24 days minimum):
- Begin with controlled practice situations
- Gradually introduce heading and full competitive play
- Continue wearing protective face mask for minimum 6 weeks post-injury
Full return:
- Complete resolution of symptoms
- Normal visual function and eye movement
- Physician clearance
Monitoring and Complications
Potential Complications
- Persistent diplopia (occurs in 37% of patients post-operatively) 4, 3
- Decreased visual acuity (reported in 74% of athletes with orbital fractures) 7
- Infraorbital numbness (21% of cases) 7
- Risk of refracture with early return
Follow-up Recommendations
- Short course of oral steroids can help reduce postoperative swelling and uncover persistent strabismus 3
- Regular ophthalmologic evaluation before clearance for return to play
- Immediate re-evaluation if new symptoms develop after return to play
Special Considerations
- Lower-grade contact sports may permit earlier return (3-10 days) compared to higher-grade contact sports (minimum 21 days) 1
- Combat sports require longer recovery periods (3 months recommended) 1
- Presence of hardware or implants may require longer protection with face mask
- Persistent diplopia in upper gaze may not prevent return to soccer but should be monitored
By following these guidelines and using appropriate protective equipment, soccer players can safely return to sport after orbital fracture while minimizing the risk of reinjury or complications.