Diving and Orbital Floor Fracture

[ahjoyn]

Two weeks ago I sustained an orbital floor fracture of my left eye and and my sinus was impacted 8mm from a blow to the face while playing basketball. I am scheduled to go on a Caribbean dive in 1 week, leaving 3 weeks of time between injury and possible dive. The bones in my face have set and there is currently no visible injury, there is no pain and my face feels normal (I know this does not mean much). Is it at all safe to attempt a shallow dive (~30ft) after recieving an injury of this type 3 weeks later, and immediately surface upon feeling any pain? In other words, descending very cautiously? Or will I be risking an even more serious injury? I have advice from doctors but was hoping to get a perspective from a diver with medical expertise.
Thank you

[Saturation]

What kind of treatment did it require?

[ahjoyn]

I recieved no treatment, I saw a specialist in opthamology plastics and he said to just apply ice 20 min on and off and to use afrin to drain blood from my sinus.
Surgery was a close call because upon feeling the fracture there seemed to be a large gap in the orbital floor, but after reviewing my CT he said it should heal fine because it was a narrow gap that still supported my eye. Now when I feel under my eye, it seems that the gap has filled in and is solid. There was no damage to my actual eye. I should add that I'm 26 yr old, and in general a quick healer, and it seems to be healing very quickly, but I don't want to take (m)any chances.

[Saturation]

Sounds like you had a linear orbit fracture, like a crack in a plate. There should be no major problems.

Theoretically, it provides an added locale for gas to escape during equalization, so should it leak, there is a potential for gas to squeeze between the tissues of the orbit, leading to subcutaneous emphysema of the orbit, i.e., air squeezing underneath the tissues of the eye.

Worse case, if the air is substantial, it may give you double vision until the air is absorbed. Otherwise, you'll just notice a crispiness to the skin around your eye.

If you get such a malady or if bleeding in the sinus occurs, it may be prudent to call the subsequent dives as it suggest the fracture is not entirely healed.

The sc. emphysema is not itself a major problem, but there is no telling how much gas can enter the soft tissue of the eye and what the temporary effects will be, or if sinus bleeding can be severe.

The red or pink arrow shows where gas can leak to, see attachment.

[Lloyd]

I would not recommend diving. The air from your sinuses can bring bacteria with it. This can cause a nasty infection which can easily spread to your brain and kill you. Not to mention the risk of blowing your eye out of the socket.
Lloyd

[Saturation]

Lloyd once bubbled...
I would not recommend diving. The air from your sinuses can bring bacteria with it. This can cause a nasty infection which can easily spread to your brain and kill you. Not to mention the risk of blowing your eye out of the socket.
Lloyd

Under normal conditions, the sinus contents are sterile and if the fracture contaminated the sinuses or infected sinuses contaminated the orbit, 3 weeks later its likely inconsequential or has healed on its own. Eye docs often give antibiotics during such injuries just in case infection is a possibility.

The risk for prolapsing the eye out of the orbit cannot be eliminated but its unlikely. At this point, its probably a question you should bring to your oculoplastics surgeon because the likelihood of this occuring depends entirely on the specifics of your injury.

[Uncle Pug]

... I like diving a lot.

But you know... I like my eyes and... well... I like my sinuses too.

If it were me I wouldn't dive.

[Lloyd]

I teach ophth. and it is very possible to get an infection from a blow out fracture. At three weeks s/p, the fracture can be blown out by a baurotrauma incident. What is the change in air volume from 33' to the surface? I would not do it. What was your MD's advice?
Lloyd