Residual diplopia in treated orbital bone fractures

Residual diplopia (RD) is the main post-treatment complication of orbital bone fracture (OBF) reduction. The cause of RD is varied and often related to the degree of inflammation, surgical timing, graft requirement, and trauma to orbital musculature, fat, as well as nerves. The exact prevalence of these and the influence of these factors on RD is not widely reported in literature.

This retrospective study was conducted from January 1, 2000 through December 31, 2011. Sixty nine patients fulfilling inclusion and exclusion criteria were enrolled in this study. The nature of the defect causing RD was identified. Demographics, nature of initial OBF, extent and type of treatment, and grafts were noted. Corrective surgeries were performed. Data entry and analysis were performed using SPSS. Descriptive statistics and Chi square tests were employed. P value ≤ 0.05 was taken as significant.

Inferior rectus muscle (71%) and other periorbital musculature (56.5%) was entrapped, leading to RD. Globe position abnormalities was observed in 52.1% of cases. Degree of inflammation, types of grafts (P = 0.000) were significantly related.

Preoperative swelling, musculature inflammation, and graft placement significantly influenced the surgical outcome of OBF. RD is related to these factors. Adequate control with OBF healing and remodeling needs to be considered while timing OBF. Author's modification with mesh and cartilage in secondary corrective surgery for RD provided an effective solution for immediate intervention.