Compressive optic neuropathy secondary to titanium mesh implant in orbital fracture. Case report

Orbital fractures are a common cause of facial trauma and may lead to significant functional impairments. Titanium mesh implants are frequently used in orbital reconstruction; however, complications can arise if improperly placed. We report the case of a 40-year-old woman who sustained cranioencephalic trauma in a traffic accident, resulting in fractures of the orbital floor and medial wall. She underwent early maxillofacial surgery without prior ophthalmologic evaluation, and a titanium mesh was implanted. Postoperatively, she developed sudden vision loss. A second surgery replaced the implant with smaller plates, but no improvement occurred. Imaging revealed persistent compression of the optic nerve and extraocular muscles. Surgical removal of the implants and orbital decompression, along with corticosteroid therapy, led to gradual visual recovery, reaching 20/40 best-corrected acuity and restoration of the central visual field. This case underscores the need for timely diagnosis and multidisciplinary management in orbital trauma to prevent permanent visual sequelae.