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Eye Pain – College Rugby Player

Abstract

M. Slaughter, K. Vanic, G. Rozea, East Stroudsburg University, PA.

email: kvanic@esu.edu (Sponsor: Kevin N. Waninger, MD, FACSM)

HISTORY: A 22-year-old male rugby player. The patient was in a scrum during a rugby match and was hit below the right eye and cheek by an opposing players elbow. Patient denies any past medical history of trauma to eye or face.

PHYSICAL EXAMINATION: Patient presented with immediate pain (9/10), diplopia, and the inability to gaze/track upward; remaining extraocular movements appeared intact. There was no obvious deformity or discoloration at time of injury. ER physicians evaluated the patient and subsequently initiated discharge instructions with NSAIDs. While awaiting final instructions, the patient blew his nose which caused swelling and periorbital ecchymosis surrounding his right eye with an increasing sensation of pain and orbital pressure. ER physician determined that diagnostic imaging would be ordered. Patient described a severe amount of pressure on the right side of his face but minimal pain (2/3) with palpation to aforementioned areas.

DIFFERENTIAL DIAGNOSIS: LeFort Fracture, Zyomatic Fracture.

TEST AND RESULTS: X-rays revealed a 3mm nondisplaced fracture along the orbital floor. No foreign bodies or other fractures were detected.

FINAL/WORKING DIAGNOSIS: Orbital Blowout Fracture TREATMENT AND OUTCOMES: Patient was referred to ophthalmologist. The patient agreed to have surgery. An endoscopic technique was used and a .85X38X50mm medpor plate was fixated to stabilize the fracture site. Patient spent 24 hours in the hospital. After he was discharged he complained of moderate levels of pain and pressure on the right side of his face as well as numbness blew his eye. Patient experienced photophobia 2-3 post-surgery. Activity restriction for 9 weeks. He was cleared to play for the last match of the season and with no ensuing complications.

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