White-Eyed Orbital Blowout Fracture: A Retrospective Study of 22 Patients

Background and Objectives The study reports on the clinical experience of repairing white-eyed orbital blow out fracture through a retrospective study of various incidences of white-eyed orbital blow out fracture that resulted in different treatment methods and outcomes.Subjects and Method A retrospective study was performed on 22 patients with white-eyed blowout fracture who underwent operation between March 2009 and June 2019 at our clinic. Patients were divided into 2 groups by age: 6 to 12 and 13 to 18. A review of medical records included demographic data, cause of injury, preoperative symptoms, trauma to operation time and surgical outcomes including improvement of postoperative ocular symptoms and complications.Results The study population included 20 males and 2 female patients ranging from 6 to 18 years (mean, 14.2 years) of age. Fifteen of 21 patients with diplopia or limitation of eyeball movement showed a complete improvement of symptoms after surgery and 6 (28.5%) had remaining symptoms. One patient had no ocular symptom, but had oculocardiac reflex including nausea and vomiting. Two cases were re-operated due to adhesion of graft material. There was one sinus infection related to the implant.Conclusion This study shows that early reconstruction and release of incarcerated muscle within 5 days after trauma for white-eyed blowout fracture gives successful result that does not accompany major complications. All of the 22 patients who were operated for white-eyed blowout fractures had successful results.

Role of orthoptics and scoring system for orbital floor blowout fracture: surgical or conservative treatment

AIM: To assess the role of orthoptics in referring patients with orbital floor blowout fracture (OFBF) for conservative or surgical treatment and based on the results, to propose a scoring system for such decision making. METHODS: A retrospective analysis of 69 patients with OFBF was performed (35 treated conservatively, 34 surgically). The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated, the factors with the highest significance for decision making were identified, and a scoring system proposed using Logistic regression. RESULTS: According to defined criteria, the treatment was unsuccessful in 2 (6%) surgically treated and only in one (3%) conservatively treated patient. The proposed scoring system includes the defect size and several values resulting from the orthoptic examination, the elevation of the eyebulb measured on Lancaster screen being the most significant. CONCLUSION: The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder (with or without binocular diplopia) in OFBF patients. The proposed scoring system could, following verification in a prospective study, become a valuable adjunctive tool.

Yearly Trends In The Prevalence of Ocular Traumas And The Effects of Covid-19: A Nationwide Population-Based Study of Korean Data

We identify the yearly trends in the prevalence of various ocular traumas in the Republic of Korea, and the effects of Covid-19. We recorded the yearly numbers of patients diagnosed with hyphema and those who underwent open reduction surgery because of orbital blowout fracture (BOF), primary closure of the cornea or sclera (PCCS), or intraocular foreign body (IOFB) removal. The incidence of closed globe injuries has decreased significantly over the past 10 years, while that of open globe injuries has not. The patients aged ≥ 60 years showed a significant increase in BOF surgery. Regarding the trend in PCCS, while other age groups showed significant decreases, the population aged ≥ 60 years did not. In addition, the population aged ≥ 60 years showed a significant increase in the incidence of IOFB. When the 2020 data were compared with those of 2019, hyphema evidenced the largest decrease (27.02%), especially in those aged < 20 years (54.33%). In terms of both BOF and IOFB, those aged < 20 years showed the largest decreases (28.85% and 47.93% respectively). In the Covid-19 era, ocular trauma fell markedly in those aged < 20 years, perhaps because of school closures and reductions in outdoor activities.

Blowout fracture-associated orbital cellulitis progressing to panophthalmitis: a case report

Background Parvimonas micra is known as a causative agent of chronic periodontal disease. This Gram-positive obligate anaerobic coccus was cultured from the ocular surface of blowout fracture-related orbital cellulitis progressing to panophthalmitis. Case presentation The patient was a woman in her fifties who had panic disorder and subsequently was a victim of domestic violence. These factors led to delayed consultation. At the initial visit to an ophthalmologist, the ocular surface of the right eye was covered with pus. Swelling of the upper and lower eyelids prevented the eyelid from closing and exophthalmos, severe corneal ulcer, panophthalmitis, and no light perception were observed. Head computed tomography revealed an old blowout fracture and chronic sinusitis with orbital cellulitis. P. micra were isolated from culture of pus samples from the sinus and from the ocular surface. Conclusions There is a possibility that P. micra invaded the orbit via the fragile bony site and caused orbital cellulitis, severe corneal ulcer, and panophthalmitis that required enucleation. In cases of coexisting old blowout fracture and chronic sinusitis, the chronic sinusitis should be treated as quickly as possible.

STRABISMUS MANAGEMENT AFTER ORBITAL BLOWOUT FRACTURE

Orbital floor fractures (OBF) account for 40% of mid-facial injuries and are therefore the most common of all trauma injuries in this region. The post-treatment complication that often follows orbital floor repair is residual diplopia or 1 persistent diplopia and is seen in 86% of the OBF cases. The causes for persistent diplopia can be varied and is often related to the degree of inflammation, trauma to 2 musculature, fat or nerves and surgical timing. Some of the common causes of the same are - malpositioning of the globe, fibrosis of the inferior fibro fatty muscular complex following trauma, direct damage to an extraocular muscle (commonly inferior rectus muscle), local injury to a motor nerve, ischemia (or compartment syndrome), iatrogenic damage during reconstructive surgery or entrapment under improperly placed alloplastic material. Our case report mentions a rare case of persistent vertical diplopia even after successful repair of orbital blowout fracture. A 15-year-old male patient following a road traffic accident presented with persistent headache and vertical diplopia. The patient was evaluated by a oral maxillofacial surgeon and a presumptive diagnosis of a case of large orbital floor fracture with entrapment of inferior rectus muscle was made which was confirmed on CT Scan. He was managed surgically by reduction of the fracture and fixation with a titanium mesh. 2 weeks post-surgery he reported to the squint clinic with complaints of persistent double vision. On comprehensive ocular examination, it was found that patient had vertical diplopia with limitation of infraduction in the left eye with negative FDT, on re-evaluation of MRI scans with 1 mm cuts, a partial left inferior rectus tear was seen and documented as the cause of persistent diplopia. Patient was treated conservatively by prescribing prismatic glasses with fusional exercises. After 6 months of follow up, the patient was relieved of diplopia in primary position but there was a residual hypotropia in downgaze for which he was prescribed prisms only for downgaze.

Detecting Binocular Diplopia in Orbital Floor Blowout Fractures: Superiority of the Orthoptic Approach

Background and Objectives: In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical therapy. However, the accuracy of the traditional test for detecting binocular diplopia/ocular motility disorder using a moving pencil or finger (hereinafter, “finger test”) has been generally accepted as correct and has not been subject to scrutiny so far. Hence, its accuracy relative to full orthoptic examination is unknown. Materials and Methods: In this paper, the results of the “finger test” were compared with those derived from a complex examination by orthoptic tests (considered “true” value in patients with OFBF). Results: “Finger test” detected ocular motility disorder in 23% of patients while the full orthoptic examination proved much more efficient, detecting ocular motility disorder in 65% of patients. Lancaster screen test and test with color filters were the most important tests in the battery of the orthoptic tests, capable of identifying 97.7% and 95.3% of patients with ocular motility disorder, respectively. Still, none of the tests were able to correctly detect all patients with ocular motility disorder in itself. Conclusions: As the presence of ocular motility disorder/binocular diplopia is an important indication criterion for the surgical solution of the orbital floor blowout fracture, we conclude that a complex orthoptic evaluation should be always performed in these patients.