Influence of time on the management of complications of orbital floor fracture

PurposeThe aim of this work is to evaluate the influence of time elapsed between the occurrence of orbital floor fracture and management on improvement of complications.Patients and methodsThis is a prospective comparative interventional study that including 17 patients with pure orbital floor fracture (without involvement of the orbital rim) who presented to Mansoura Ophthalmic Center from January 2012 to September 2012; they presented with diplopia with or without enophthalmos. For all cases, computed tomography-coronal cuts were performed. For all cases, repair of the orbital floor fracture was performed using a titanium mesh. For cases that had persistent diplopia after repair because of restrictive myopathy, adjustable inferior rectus recession was performed. Those who did not achieve correction after recession were corrected by prisms. Cases were followed for 6 months after surgery.ResultsThis study included 17 cases with pure orbital floor fracture. They were divided into two groups according to the time of presentation after trauma: group A included seven (41.2%) patients who were operated within 3 weeks of trauma and group B included 10 (58.8%) patients who were operated after 3 weeks up to 6 months of trauma. In group A, all cases presented with diplopia in up gaze; however, one (14.3%) case presented with enophthalmos more than 2 mm.In group B, all cases presented with diplopia in up gaze and three (30%) of them presented with enophthalmos more than 2 mm. In group A, diplopia and enophthalmos were completely resolved after surgical repair of orbital floor fracture; however, in group B, diplopia improved only in two (20%) cases, but cases of enophthalmos were completely resolved. Among the remaining eight (80%) patients with persistent diplopia who underwent adjustable inferior rectus recession, seven (70%) patients improved and only one (10%) patient had persistent diplopia that was corrected with prisms.ConclusionEarly repair of orbital floor fracture (within 3 weeks) leads to complete improvement in diplopia; however, late repair in most of the cases needs inferior rectus recession and sometimes prism correction. However, enophthalmos is not affected by the time of repair.