TITLE

Delayed immediate surgery for orbital floor fractures: Less can be more

AUTHOR(S)
Tang, David T.; Lalonde, Jan F.; Lalonde, Donald H.
PUB. DATE
December 2011
SOURCE
Canadian Journal of Plastic Surgery;Winter2011, Vol. 19 Issue 4, p125
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Orbital floor fractures can result in diplopia, enophthalmos, hypoglobus and infraorbital dysthesia. Currently, the most common treatment for orbital floor fractures is immediate surgical intervention. However, there are a number of well-documented cases of unoperated orbital floor fractures in the literature, culminating in diplopia or enophthalmos in few patients. Of these, none reported the diplopia or enophthalmos to be bothersome. As reported previously in the ophthalmology literature, most orbital floor fracture-induced diplopia resolves as the swelling settles, and the few patients with remaining diplopia can successfully be treated with surgery on the uninvolved eye. It has also been commented that most patients with enophthalmos are asymptomatic. The authors' institution has more than 50 surgeon-years experience with delaying immediate surgery for two weeks to allow time for the swelling-induced diplopia to resolve. In the authors' experience, true entrapment of the inferior rectus muscle is rare. The present article describes a study of late follow-up (average 945 days) of 11 nonoperated patients with orbital floor fractures. In the eight patients who initially presented with diplopia, there was resolution of functionally limiting double vision. Only one patient had asymptomatic, but measurably significant, enophthalmos at -3 mm. All patients had full restoration of extraocular movements and resolution of infraorbital dysthesia. None of the patients were exposed to the operative risks of ectropion, infection, implant extrusion, bleeding or blindness. The present study provides level IV evidence that delaying surgery up to two weeks after orbital floor fracture may avoid unnecessary surgical risks and inconveniences in many patients with orbital floor fracture.
ACCESSION #
70836027

 

Related Articles

  • Gamma knife radiosurgery for primary orbital varices: a preliminary report. Desheng Xu; Dong Liu; Zhiyuan Zhang; Yipei Zhang; Guoxiang Song // British Journal of Ophthalmology;Sep2011, Vol. 95 Issue 9, p1264 

    Aim The aim of this retrospective study is to evaluate the authors' experience using gamma knife radiosurgery in the management of primary orbital varices. Methods Fourteen patients, six males and eight females, with ages ranging from 7 to 56 years of age, were treated with gamma knife...

  • diplopia.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p659 

    A definition of the term "diplopia" which refers to the perception of two images of a single object is presented.

  • The Prisoner's Dilemma. Gurwood, Andrew S. // Review of Optometry;5/15/2006, Vol. 143 Issue 5, p130 

    The article describes a case of diplopia in a 35-year-old male patient. The patient's diplopia was mostly horizontal with some episodes containing a vertical component. Its frequency was intermittent that worsens at the end of the day. He believes that his diplopia was due to inactivity from...

  • Painful vertical diplopia as a presentation of a pituitary mass. Bansal, Shveta; Mandal, Kaveri; Kamal, Ahmed // BMC Ophthalmology;2007, Vol. 7, p4 

    Background: Pituitary tumours may present with a variety of neurological and endocrinological signs and symptoms. It is very rare however for them to present with sudden onset painful diplopia.The current literature and possible mechanisms for this are discussed. Case presentation: We describe...

  • Bilateral orbital metastases in a woman with breast carcinoma. Zambarakji, H. J.; Simcock, P. R.; Kinnear, P. E. // Journal of the Royal Society of Medicine;Dec1997, Vol. 90 Issue 12, p684 

    The article presents a medical case in which a woman patient aged 49, with breast carcinoma was suffering from bilateral eye or orbital metastases. She was referred to the ophthalmology department with a 9-month history of increasing diplopia on right lateral gaze with limitation of abduction in...

  • Key factors help clinician assess strabismus, diplopia. Charters, Lynda // Ophthalmology Times;8/1/2004, Vol. 29 Issue 15, p52 

    Reports on factors that help clinicians assess strabismus and diplopia. Congenital or acquired neurologic disease. INSET: Take-Home Message.

  • Diplopia Associated with Refractive Surgery. Kushner, Burton J. // American Orthoptic Journal;Jan2012, Vol. 62 Issue 1, p34 

    When diplopia occurs after refractive surgery, a systematized approach to diagnosis and treatment is useful. First, determine if the problem is monocular or binocular. Monocular diplopia usually is caused by anterior segment complications and should be referred to an anterior segment surgeon. If...

  • EYELID MYOKYMIA.  // Review of Optometry;4/15/2008 Supplement, Vol. 145, p8A 

    The article discusses the symptoms of eyelid myokymia, as well as its management. Patients with superior or oblique myokymia (SOM) present with a vertical jerk nystagmus, oscillopsia, and transient diplopia. It notes that myokymia of the eyelid is often a benign, self-limited disorder, with no...

  • Superior Oblique Overaction With Limited Binocularity.  // Journal of Pediatric Ophthalmology & Strabismus;May/Jun2006, Vol. 43 Issue 3, p134 

    Presents a quiz concerning a case report that involves a 6-year-old boy with oblique overaction and limited binocularity.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics