Resolution of diplopia after 33 years

Area of Science:

• Ophthalmology
• Plastic Surgery
• Oculoplastics

Background:

• Orbital floor fractures can lead to long-term complications such as persistent diplopia.
• Silastic implants, while used for orbital reconstruction, may carry risks of late complications.

Observation:

• A 54-year-old male presented with acute orbital cellulitis and unresolved diplopia.
• He had a history of a right orbital floor fracture treated with a silastic implant 33 years prior.
• Computed tomography revealed inferior rectus muscle displacement and entrapment of inferior and medial recti.

Findings:

• Surgical removal of the displaced silastic implant via a Caldwell-Luc approach was performed.
• Complete resolution of diplopia was achieved post-operatively.
• Resolution of acute orbital cellulitis was also noted.

Implications:

• This case highlights the potential for delayed complications from orbital implants, including infection and persistent extraocular muscle dysfunction.
• Surgical intervention, including implant removal, can effectively treat long-standing diplopia and associated orbital pathology.
• Oculoplastic surgeons should consider long-term implant integrity and potential sequelae in patients with a history of orbital reconstruction.