Orbital Floor & Wall Fracture


Orbital floor and wall fracture is s common finding seen in car accident. When a blunt trauma hit onto the globe, the force will transmit and break the thinner and more fragile medial and floor below. It can cause entrapment of muscle / sudden expansion of orbital space leading to disruption of eye muscle pulleys system and subsequently double vision.

The sudden expansion of orbital space also causes eye to look sunken which will worsen with time. Sadly, they are commonly dismissed and lead to patients suffer intractable double vision and facial disfigurement. The similar condition can also occur in children. The child usually does not complain much except initially nausea and vomiting due to vagal reflexes. If left untreated the double vision is usually present for life.

Discontinuation of orbital floor bony margin indicates fracture.

  • Discontinuation of orbital floor bony margin indicates fracture.

Provided Physiotherapies

Treatment

Studies showed early intervention yield better outcome and hence it is important to seek oculoplastic surgeons’ opinions early.  Currently, Dr Ho also using intraoperative navigation (First in Perak) to enhance precision of the plate insertion .

In children, patient may only complain of double vision once and they quickly adapt.  Some of them may have nausea vomiting.  Usually their eyes look white.  However, it is important to operate as soon as possible to prevent permanent entrapment of  muscle and subsequent ischemia (dying ) of muscle and permanent diplopia (double vision).  

Right eye deviated out. It was assumed due to CN III palsy.

  • Right eye deviated out. It was assumed due to CN III palsy.

Pre op:  After a near fatal accident, for many months post op he was diagnosed to have CN III palsy and assume the eye deviation will follow for life.

Post op:  After replacing the floor , the eye no longer deviated out.

Limitation in upgaze

  • Limitation in upgaze

Pre op:  Limitation in upgaze after a car accident

Post op:  no more difficulty in looking up after orbital floor fracture repair.

Limited in right eye downgaze

  • Limited in right eye downgaze

Pre op: impaired downgaze with orbital floor fracture

Post op:  Improved downgaze after orbital floor fracture repair

Pre Op:  The left eye has sunken in secondary to volume expansion after a fracture in the floor of orbit.

Post op:  improved symmetry post orbital floor fracture repair

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