Delayed Management of an Orbital Floor Blow-out Fracture

Abstract

A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enophthalmos, hypoglobus, or strabismic diplopia. Several surgical approaches for repair have been described in the literature. This report is a description of an illustrative case and a brief summary of the literature related to the transconjunctival approach to orbital floor fracture repair as performed by ophthalmologists. A 19-year-old female patient had fallen from a 5-meter-high fence and sustained panfacial fractures, including both orbits and the surrounding sinuses. An acute repair was performed by a maxillofacial team to stabilize the facial structure . Following neurosurgical stabilization, she was referred to ophthalmology with pronounced hypoglobus and enophthalmos, diplopia, relative afferent pupillary defect, and a slightly pale right optic nerve head. Surgery was performed under general anesthesia using the transconjunctival approach and an alloplastic implant. This approach was effective, providing excellent exposure while reducing the risks of lower eyelid retraction and surgical scars associated with the transcutaneous approach.

Keywords: Enophthalmos; hypoglobus; orbital fracture; transconjunctival approach.

Figure 1.

CT scans at the initial presentation showing. (a) Axial scan with lateral and medial wall fracture. (b) Coronal scan with floor and medial wall fractures.

Figure 2.

The clinical examination performed seven months after the initial surgery showing the (a) hypoblobus and enophthalmos, (b) right eye, (c) left eye (d) CT coronal scan with the floor and medial wall fracture.

Figure 3.

Surgical management via (a) Transconjunctival approach, (b) and (c) exposure of the orbital floor.

Figure 4.

Patient at 14 weeks follow-up with improved (a) hypoglobus and enophthalmos (b) CT scan at 14 weeks follow up.