Challenges of Managing Orbital Floor Blow–out Fracture in a Developing Country

Abstract

Background: Orbtal blow-out fracture can be associated with ocular injuries which may involve the anterior or posterior segments of the eye. This can present significant morbidity to patients which can impact on the quality of life.
Objective: To evaluate cases of orbital floor blow-out fractures seen at two centres.
Methodology: A retrospective study of patients seen with a diagnosis of orbital blow-out fracture between July 2009 and March 2010 was done. Diagnosis was based on history, clinical examination and computerised tomography (CT) scan. The patients had lower lid incision – transcutaneous or transconjunctival. Silicone and bone implants were used to reconstruct the defects.
Results: Five patients – 3 males and 2 females were reviewed, age range between 21 to 26 years. The fracture occurred as a result of road traffic injury in 3 patients (60%), and the involved eye had poor visual acuity on presentation, but no associated ocular injury was noticed in 3 (60%) of the patients. The interval between injury and presentation ranged from 9 to 120 days. Vertical limitation of ocular motility and significant enophthalmos were noticed in all the 5 patients; 2 had diplopia and hypoesthesia in the distribution of the infraorbital nerve. The average time interval between injury and surgery were 49 days and 3 of the patients (60%) had repairs after 14 days of presentation. Postoperatively, slight improvement in ocular motility was observed.
Conclusion: The challenges of managing orbital fracture include late presentation, lack of synthetic implant materials, increased morbidity with graft harvesting, and poor cosmetic outcome.

Keywords: Challenges, enophthalmos, road traffic injury