Quantitative assessment of lower eyelid morphology following orbital floor fracture repair

Orbital floor fractures are treated using various surgical approaches; however, objective quantitative evaluation of postoperative lower eyelid morphology remains limited. This study assessed approach-specific changes in postoperative eyelid configuration.

We retrospectively reviewed 35 patients with orbital floor fractures, including 26 surgically treated and 9 conservatively managed patients. Morphometric measurements were performed in all patients using standardized frontal photographs obtained ≥6 months after injury or surgery. Surgical comparisons included the transconjunctival approach (TCA; n = 7), swinging eyelid approach (SEA; n = 13), and subciliary approach (SCA; n = 6). Photographs were measured by two independent observers using ImageJ, and mean values were analyzed. Horizontal palpebral fissure width, lateral canthal height, lateral canthal angle, and lower eyelid curvature were assessed. Paired tests, Kruskal-Wallis tests, and Steel-Dwass comparisons were used, as appropriate.

Horizontal palpebral fissure width and lateral canthal height showed no significant intergroup differences on the affected side (χ² = 2.50, p = 0.286; χ² = 4.49, p = 0.106, respectively). Lateral canthal angle decreased in SEA and increased in SCA, with a significant SEA-SCA difference (mean difference, -7.19°; p = 0.026). Lower eyelid curvature was relatively preserved in TCA, although intergroup differences were not significant (χ² = 4.45, p = 0.108). No major complications occurred.

TCA showed favorable preservation of lower eyelid morphology. SEA and SCA were associated with subtle, approach-specific changes in lateral canthal angle and eyelid contour. Objective morphometric assessment may complement postoperative eyelid outcome evaluation.