EYE INJURIES AND ORBITAL FRACTURES - The Ultimate Guide to Preventing and Treating MMA Injuries: Featuring advice from UFC Hall of Famers Randy Couture, Ken Shamrock, Bas Rutten, Pat Miletich, Dan Severn and more! (2016)

The Ultimate Guide to Preventing and Treating MMA Injuries: Featuring advice from UFC Hall of Famers Randy Couture, Ken Shamrock, Bas Rutten, Pat Miletich, Dan Severn and more! (2016)




UFC and MMA veteran light heavyweight Brandon Vera has had some scary moments with facial injuries, including one significant orbital fracture. “After my fight with Randy Couture, I fought Jon Jones. I had a tripod orbital fracture on the right side of my face, which I received from one of Jon Jones’s elbows. A piece of bone went behind my eye and I had to have significant reconstruction surgery. To this day, it’s my worst injury — pain-wise and in terms of recovery. The injury was so severe that the doctors worried whether I would have vision in that eye, and I worried about when I would fight again. During my next fight, with Thiago Silva, I broke my nose from a hook while on the ground. I couldn’t get the juice monkey off of me. I noticed it right after my fight, while looking on the camera. I remember looking at it and thinking, ‘Holy shit, I hope the doctors can put it back together and make me good-looking again.’ It was actually a blessing in disguise. My whole life I had a deviated septum. I never understood when people said breathe through your nose until after my surgery and healing process. I could now finally breathe through my nose. To date that was my third most painful surgery, and I had to have my nose fixed. I don’t understand how people get that done as an elective procedure!”

Eye injuries in MMA typically fall under two main categories: abrasions and blunt trauma. Abrasions usually occur when the eye is scratched by a fingernail, a toe, or even a glove. The cornea is the clear portion that covers the center of the eye. When the cornea is injured, it feels like a sharp pain and often gives the sensation that there is something in the eye. Doctors are usually able to diagnose this by putting a special dye into the eye and seeing if a scratch or tear appears bright with a special fluorescent light. Because the pain is often so bad and even bright lights cause the eye to want to close, it would be very difficult for a fighter to adequately defend himself after this occurs. Treatment is usually with antibiotic drops to prevent infection, but this requires seeing a doctor. If a fighter fails to see a doctor, and the eye gets infected, a minor scratch can became a nightmare. Treated appropriately, minor scratches can heal in just a couple of days. Larger abrasions may take a little longer.

Sometimes, bleeding can actually happen inside the eye itself. When this happens, a layer of blood inside the eyeball may cover some of the iris and the pupil. This is called hyphema. Treatment usually consists of preventing further bleeding, such as bed rest with the head of the bed elevated. Often these bleeds are small and resolve on their own, but sometimes they can progress and this can lead to permanent vision problems, including glaucoma. Anti-inflammatories may increase a fighter’s risk of further bleeding and should be avoided in this injury.

The more serious eye injuries may come from blunt trauma. The major part of the eye is a fluid-filled oval structure known as the globe. With compression of the globe, the retina or optic nerve at the back of the eye may be injured or torn. The eye focuses light on the retina similarly to how a camera focuses light onto a sensor. The retina translates that focused image into nerve impulses and sends them to the brain via the optic nerve. If the retina is damaged, the fighter may see flashes of light, or “floaters.” If it tears completely, a person could become blind. Therefore, if a fighter starts to see these “floaters,” no matter what stage of his career, he should see an eye doctor. With enough force applied to the eye, the globe itself can actually rupture. This usually results in pain, vision loss, or even leakage of the fluid within the globe. This type of injury often requires prompt evaluation by an ophthalmologist (eye doctor). This can be a surgical emergency. Thus, a fighter and his trainer should be familiar with these signs of serious injury.


1. Staying in shape, both anaerobic and aerobic

2. Flexibility

3. Coaches paying attention to fatigue and keeping fighters moving in good form


If the blunt force is strong enough, the orbital bones or other bones that are near the eye can fracture (which is the same as a break). It was at UFC 10, which marked the UFC’s return to a format featuring an eight-man tournament, that Don “The Predator” Frye suffered his most significant facial fracture against Mark “The Hammer” Coleman. “During UFC 10, Mark Coleman broke my orbital. I remember waking up that day feeling sick, but I kept fighting the whole time. I certainly put myself at risk. When you’re an athlete and in tune with your body, you know something is wrong, and I knew it.

“My first fight was against Mark Hall. I wore myself out with him. I went for the ribs instead of head and tired myself out. Then in my second bout of the night, I fought judo black belt and Golden Gloves winner Brian Johnston. He is a powerful guy and kicked me hard a couple times. I thought I might need to quit, but I managed to win the fight. Backstage after the fight, my trainer Steve Owen saw I was completely tired and dehydrated. We discussed pulling out of the finals against Mark Coleman. But I sat in that chair and I looked around at the alternates. I thought to myself there is no way I would send these kids in to the lions, to face Mark Coleman. So I went in there to take my beating.”

UFC veteran Nick Diaz also suffered an orbital fracture. His coach Cesar Gracie recalls the story, “Nick had an orbital fracture. We think it probably got broken against Gomi in Pride. We never got any x-rays at the time, but he had a lot of bruising. After another fight, he got x-rays and they saw the fracture. He had to let it heal with time. Sensitivity was our guide. Anytime someone has a face fracture, we make sure to use masks. We have masks for training, especially for broken noses. The ones we use are not bulky like boxing but slimmer for MMA. If the fighter needs to stay busy during the healing process, we put headgear on, plus a mask.”

As mentioned before, elbows are especially dangerous around the face. They can open up big cuts, but the focused force can also cause a facial fracture. UFC Welterweight Champion Carlos Newton felt firsthand what it’s like to have a broken facial bone from an elbow blow. “In the first round of my fight with Charuto at UFC 46, he threw a funny punch during a ground-and-pound and I felt a pop in my cheek. After my decision loss, the ringside doctor saw me. I felt okay and looked okay to him. But as it turned out, I probably ended up breaking my orbital bone. The broken bone formed a bump when it healed, which created a point that leads to bruising and easy cutting. Of course, this led me to develop a better skill of not getting hit in the face… . When it comes to face injuries, you really need to watch out for elbows. They can generate enough force and the bone comes to a point, which easily causes injury like orbital fractures. I always found it interesting that in Japan, where they have very competitive rules, despite being able to kick a guy while he was down like in Pride, we couldn’t throw elbows. What is also dangerous is that orbital fractures don’t usually end a fight and can get overlooked.”


Ninety percent of eye injuries in other sports can be prevented with eye protection; unfortunately, this is not possible in MMA. Other than a physical barrier, there isn’t anything anyone can do to “strengthen” the eye against injury. Top striking coach Mike Winkeljohn has personally felt the effects of getting poked in the eye by a kick, and the consequence was serious. “I was holding pads and not paying attention and got a toenail to my eye, injuring my globe. I asked the person that kicked me if I was cut. He goes, ‘No, coach, it’s your eyeball.’ I felt moisture, and it was all the fluid from inside my eye. It just shriveled up like a little grape. I was in shock, so I didn’t feel it. I saw my doctor’s face after she examined me and knew something was bad. I underwent four surgeries before the optic nerve died and I lost vision out of that eye.”

Cesar Gracie has noticed two things that can prevent eye pokes. “In training, most guys use the 6-8 oz gloves, so it’s harder to straighten your fingers, but when they step in the cage with the 4 oz gloves, they straighten their fingers and that can lead to more eye pokes in the cage. The other thing guys can do is keep fingernails and toenails clipped. In kickboxing especially, the feet and toes are exposed under the pads and can lead to eye pokes.”

Like most aspects of training, using the right equipment for training exercises is important. Traditional boxing gloves are mostly rounded and the fingers are contained, reducing the incidence of eye pokes. MMA gloves, however, allow the fingers to be exposed, which is crucial for grappling. Furthermore, MMA often involves unorthodox striking, including open hand or overhand strikes that can easily result in a thumb to the eye. UFC Hall of Famer Pat Miletich understands there is a balance between using MMA gloves for grappling, but boxing gloves for striking. He makes sure his fighters always wear boxing gloves when striking, both for safety and technique. “Guys with MMA gloves develop bad habits like not hitting fully and leaning back to avoid fingers coming into eyes. I have my guys use MMA gloves for grappling technique in the morning but full boxing gloves at night for striking practice.”

MMA is a sport where injuries can easily happen. It is the job of everyone involved, from the trainers and fighters to the referees and ringside physicians, to do what they can to help prevent injuries. However, when injuries do occur, and they will, the team needs to do what’s best for the fighter. If there are any signs of eye damage, the fight or training session should be stopped. Not being able to see out of an eye puts the fighter at risk of further damage. If a fighter does lose sight in one eye, he will be hard-pressed to find a commission or doctor who would ever let him fight again.

Many fighters focus on preserving their body, but they should also focus on preserving their mind. The biggest key to successful combat and competition is complete mental preparation. So, what is mental preparation and how do you train your mind?

Most sporting competitions come down to decisions made in milliseconds by your body. Other times you may have to react without even making a conscious thought. This quick reaction is accomplished from training. The body and the mind need to work in unison. Your mind is a supercomputer able to compute under extreme stress, but when the mind is not prepared, it becomes consumed with fear and other distractive information. Training the mind is as, if not more, important as physical training. When you train in martial arts or competitive sports, you are wiring your brain and your body to interact and react together.

There are several tools one can employ to create a strong mental preparation routine for MMA. The first tool is visualization. Visualization is a broad term that sports psychologists use to describe techniques where we imagine ourselves performing sport-specific tasks, including what we feel, see, hear, and touch. This helps establish a routine and also prepare us for the situations that may arise in competition. By “experiencing” these moments beforehand, we can react quicker and more predictably when the actual situation arises. In truth, most of us visualize already, but we fill our minds with daydreams of what we wish our life to be. This is not true, focused visualization training. Actual mental training takes practice and patience and focuses on a specific goal.


1. Strengthening

2. Stretching

3. Icing

For example, with grappling, I visualize performing each technique and how each technique flows to the next and how those techniques tie together to accomplish my goal of submitting my opponent. This can apply to any practiced movements with your body that you can visualize in your mind — golf, baseball, boxing, even playing music.

You may notice during your visualization training that your heart rate may elevate or your body may tense. This is the mind connecting to your body. The ability to control this stimulation can be found with quiet breathing exercises and meditation. If we return to the brain-as-supercomputer analogy, meditation is the time to defragment your hard drive and reboot back up with new, cleanly organized information. Meditation complements the physical training process by relaxing the body and clearing doubts, fears, and other confusing thoughts. During meditation you can slow your thoughts, relax your mind, and begin to analyze any anxieties or fears you may have. I even use it before broadcast announcing where I know my face will be in front of millions of people watching at home.

Finally, the third component of proper mental preparation is focusing on slow, controlled physical movement. Physical forms such as yoga, t’ai chi, or shadowboxing are all techniques that can help wire the body and mind together in a controlled and relaxed environment. This helps you focus on keeping good form for when you go full speed.

Through the use of these three tools — visualization, meditation, and slow physical forms — you will be able to perform at your peak during MMA competition. When people say it’s all in your mind, they are exactly right.

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