Are We Overoperating on Isolated Orbital Floor Fractures?

Area of Science:

• Ophthalmology
• Plastic Surgery
• Radiology

Background:

• Current surgical indications for orbital floor fractures include defect size and inferior rectus (IR) rounding index to prevent late enophthalmos.
• The positive predictive value (PPV) of these indications requires further analysis.

Purpose of the Study:

• To evaluate the predictive accuracy of orbital floor defect size and IR rounding index for developing late enophthalmos.
• To determine if these parameters are reliable indicators for surgical intervention.

Main Methods:

• Twenty-eight patients with orbital floor fractures and no initial enophthalmos were monitored.
• Hertel exophthalmometry was performed serially post-injury.
• Orbital defect size and IR rounding index were measured via CT scans.

Main Results:

• Defects ≥1.5 cm² had a 6.7% PPV for enophthalmos; defects ≥2.0 cm² had a 0% PPV.
• An IR rounding index ≥1 had a 0% PPV for enophthalmos.
• Only three patients developed mild enophthalmos (≤2 mm) over a mean follow-up of 440 days.

Conclusions:

• Orbital defect size and IR rounding index are weak predictors of late enophthalmos in patients without initial enophthalmos.
• Enophthalmos developing within 3 weeks of injury is unlikely to progress significantly (>2 mm).
• The current indications for surgery may need re-evaluation based on these findings.