Floor Orbital Fracture Follow-up

  • Author: Geoffrey M Kwitko, MD, FACS, FICS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 15, 2012
 

Further Outpatient Care

  • The surgeon should evaluate the patient's vision in the recovery room postoperatively as soon as the patient is alert enough to cooperate.
    • The vision after surgery should be essentially the same as preoperative vision, and no afferent pupil should be present (assuming no afferent pupil was present preoperatively).
    • The surgeon should inspect for signs of excessive retrobulbar hemorrhage, such as proptosis or increased intraocular pressure.
    • Patients should be seen the next day in the office and evaluated for vision, pupils, motility, and intraocular pressure.
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Inpatient & Outpatient Medications

  • Start patients on a combination steroid/antibiotic ointment on the wound 4 times per day and have them follow up in 1 week.
  • A broad-spectrum antibiotic is used postoperatively in elderly or immune-compromised patients along with analgesics of choice.
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Deterrence/Prevention

  • The use safety glasses in all contact sports may prevent many eye injuries. The lenses should be made of polycarbonate, and the frames should be larger than the orbital entrance.
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Complications

  • Surgical complications may include loss of vision, traumatic optic neuropathy, diplopia, overcorrection or undercorrection of enophthalmos, lower eyelid retraction, bleeding, infection, extrusion of the implant, infraorbital nerve damage with resultant hypoesthesia, orbital congestion, and epiphora.
  • Most complications are the result of either malpositioning the implant or using the wrong size implant.
  • Occasionally, trauma to the inferior rectus occurs during the attempt to release it from the fracture site. Palsy may result. This usually resolves spontaneously but may take as many as 3 months to resolve.
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Prognosis

  • Most cases do well, and most patients obtain resolution of diplopia and correction of enophthalmos.
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Patient Education

  • Warn patients to avoid strenuous activity and to use common sense when determining their postoperative activity level.
  • Warn patients to avoid nose blowing for several weeks after the injury and repair.
  • Educate patients about nerve damage recovery. An injured motor nerve (third nerve branch) or sensory nerve (infraorbital nerve) can take weeks or months to return to normal. In some cases, the damage may be permanent.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center and Skin, Hair, and Nails Center. Also, see eMedicine's patient education articles Black Eye and Bruises.
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Contributor Information and Disclosures
Author

Geoffrey M Kwitko, MD, FACS, FICS  Clinical Associate Professor, Department of Ophthalmology, University of South Florida

Geoffrey M Kwitko, MD, FACS, FICS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and International College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Ron W Pelton, MD, PhD  Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Della Rocca RC, Nassif JM. Blowout fractures. In: Linberg JV, ed. Oculoplastic and Orbital Emergencies. Appleton & Lange; 1990:155-165.

  2. Green RP Jr, Peters DR, Shore JW, et al. Force necessary to fracture the orbital floor. Ophthal Plast Reconstr Surg. 1990;6(3):211-7. [Medline].

  3. Kersten RC. Blowout fracture of the orbital floor with entrapment caused by isolated trauma to the orbital rim. Am J Ophthalmol. Feb 15 1987;103(2):215-20. [Medline].

  4. Bansagi ZC, Meyer DR. Internal orbital fractures in the pediatric age group: characterization and management. Ophthalmology. May 2000;107(5):829-36. [Medline].

  5. Rubin PAD, Bilyk JR, Shore JW. Management of orbital trauma: fractures, hemorrhage, and traumatic optic neuropathy. Focal Points: Clinical Modules for Ophthalmologists. 1994;12:7.

  6. Gilbard SM, Mafee MF, Lagouros PA, et al. Orbital blowout fractures. The prognostic significance of computed tomography. Ophthalmology. Nov 1985;92(11):1523-8. [Medline].

  7. Tan Baser N, Bulutoglu R, Celebi NU, Aslan G. Clinical management and reconstruction of isolated orbital floor fractures: The role of computed tomography during preoperative evaluation. Ulus Travma Acil Cerrahi Derg. Nov 2011;17(6):545-53. [Medline].

  8. Smith B, Regan WF. Blow-out fractures of the orbit: mechanism and correction of internal orbital fracture. Am J Ophthalmol. 1957;44:733.

  9. Piombino P, Iaconetta G, Ciccarelli R, Romeo A, Spinzia A, Califano L. Repair of orbital floor fractures: our experience and new technical findings. Craniomaxillofac Trauma Reconstr. Dec 2010;3(4):217-22. [Medline]. [Full Text].

  10. Jordan DR, Allen LH, White J, et al. Intervention within days for some orbital floor fractures: the white-eyed blowout. Ophthal Plast Reconstr Surg. Nov 1998;14(6):379-90. [Medline].

  11. Egbert JE, May K, Kersten RC, et al. Pediatric orbital floor fracture : direct extraocular muscle involvement. Ophthalmology. Oct 2000;107(10):1875-9. [Medline].

  12. Magaña FG, Arzac RM, De Hilario Avilés L. Combined use of titanium mesh and resorbable PLLA-PGA implant in the treatment of large orbital floor fractures. J Craniofac Surg. Nov 2011;22(6):1991-5. [Medline].

 
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Coronal CT scan of orbits demonstrating loss of orbital floor on the left in contrast to the normal orbital floor on the right.
 
 
 
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