eMedicine Specialties > Ophthalmology > Orbit

Orbital Fracture, Zygomatic: Follow-up

Author: Stuart Seiff, MD, FACS, Emeritus Professor of Ophthalmology, University of California San Francisco; Chief, Department of Ophthalmology, San Francisco General Hospital; Consultant, Oculofacial and Aesthetic Plastic Surgery, California Pacific Medical Center and Mills Peninsula Medical Center
Coauthor(s): Jesus Torres, MD, Fellow, Section of Oculoplastic Surgery, Hospital de Viladecans, Spain; Dan D DeAngelis, MD, FRCS(C), Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto; Susan Carter, MD, Clinical Associate Professor of Ophthalmology, Institute of Ophthalmology and Visual Science, New Jersey Medical School
Contributor Information and Disclosures

Updated: May 13, 2009

Follow-up

Further Outpatient Care

  • Follow-up care is essential for the evaluation of surgical success. Masticatory function, globe position, and restoration of normal facial anatomy are all important elements that need to be critically addressed in the postoperative period.

Inpatient & Outpatient Medications

  • Most surgeons place patients on oral antibiotics and oral pain medications; they often order a short course of oral steroids as well.

Complications

  • The complications of an inadequately or unreduced zygomatic fracture are very difficult to correct secondarily. Malunion is the most common complication of zygomatic fractures and is the result of improper reduction and fixation, resulting in malocclusion, facial asymmetry, and enophthalmos.
  • Extraocular muscle entrapment, although usually attributable to the initial fractures, also can occur secondary to fracture repair. The rare complication of sudden onset blindness resulting from retrobulbar hemorrhage following reduction of even simple zygomatic fractures means that, in some instances, this procedure may be unsuitable for outpatient surgery. This serious complication, although rare (0.3% of treated zygomatic fractures), is potentially reversible upon early recognition of the symptoms and signs of retrobulbar hemorrhage (eg, pain, proptosis, loss of vision, decreased motility). If the surgeon suspects a retrobulbar hemorrhage, a lateral canthotomy and cantholysis should be performed as soon as possible. This should be completed at the bedside if the patient has visual compromise and is not near the operating suite.

Prognosis

  • Indicators of favorable outcome include bony union, absence of skeletal or soft tissue deformity, and a normal range of mandibular movement.

Patient Education

  • Advise patients to avoid nose blowing for fear of orbital emphysema and potential blindness. Also, warn them of the signs and symptoms of orbital/retrobulbar hemorrhage. Advise patients to call the surgeon at any time if orbital bleeding is suspected.
  • For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education article Facial Fracture.

Miscellaneous

Medicolegal Pitfalls

  • Physicians need to be reminded to perform a complete examination prior to embarking on surgical repair. Complete ophthalmic evaluation should include assessment for a ruptured globe and retinal detachment. These are a few of many pathologies that need to be ruled out. Adequate consultation for ancillary problems, such as malocclusion, should be obtained.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.



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Multimedia: Orbital Fracture, Zygomatic
References
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References

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Further Reading

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Keywords

zygomatic orbital fracture, zygomatic orbital fractures, zygomatic fracture, zygomatic fractures, tripod fracture, facial fracture, facial bone fracture, orbit, orbital rim, ophthalmic injury, eye injury, trimalar fracture

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Contributor Information and Disclosures

Author

Stuart Seiff, MD, FACS, Emeritus Professor of Ophthalmology, University of California San Francisco; Chief, Department of Ophthalmology, San Francisco General Hospital; Consultant, Oculofacial and Aesthetic Plastic Surgery, California Pacific Medical Center and Mills Peninsula Medical Center
Stuart Seiff, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, and California Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Jesus Torres, MD, Fellow, Section of Oculoplastic Surgery, Hospital de Viladecans, Spain
Jesus Torres, MD is a member of the following medical societies: American Academy of Ophthalmology and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Dan D DeAngelis, MD, FRCS(C), Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto
Dan D DeAngelis, MD, FRCS(C) is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, California Medical Association, Canadian Medical Association, Canadian Ophthalmological Society, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Susan Carter, MD, Clinical Associate Professor of Ophthalmology, Institute of Ophthalmology and Visual Science, New Jersey Medical School
Susan Carter, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Ophthalmic Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Medical Editor

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 Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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 Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

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.

 
 
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