Medial orbital wall fractures: complications and management

Medial wall fractures are often overlooked during routine radiographic examination and rarely develop complications. We present complications associated with medial wall fracture in six cases. Complications from medial rectus muscle entrapment include restricted and painful abduction, pseudo-sixth-nerve paresis and pseudo-Duane's-retraction syndrome. Massive orbital emphysema, in one case, was responsible for temporary loss of vision prior to definitive treatment. Two patients developed severe enophthalmos secondary to the medial wall fractures. We suggest that orbital exploration is indicated for painful or limited ocular motility, significant diplopia, severe orbital emphysema, or severe enophthalmos. An inferior approach to the medial wall through the lower eyelid provides good exposure and minimal cosmetic deformity. Postoperative complications included transient paresis of the medial rectus muscle, residual motility disturbance, and residual enophthalmos.