From the Guidelines
The clinical significance of an orbital floor blowout fracture is that it can lead to restrictive strabismus, enophthalmos, and diplopia, which can significantly impact a patient's quality of life, and therefore, prompt evaluation and treatment are essential to prevent long-term morbidity and mortality. The management of orbital floor fractures involves a thorough examination, including vision testing, refraction, pupillary examination, and imaging studies such as computed tomography or magnetic resonance imaging 1. The goals of treatment are to eliminate diplopia in the primary position and downgaze, enlarge the field of binocular single vision, and restore proper eye function and aesthetics 1. The timing of surgical repair is crucial, with immediate repair indicated for patients with entrapped muscle or periorbital tissue, and repair within 2 weeks recommended for symptomatic diplopia with positive forced ductions or entrapment on CT 1. Some patients may benefit from delayed repair or observation, depending on the severity of their symptoms and the presence of enophthalmos or hypoglobus 1. It is essential to consider the individual patient's anatomy and the degree of concavity of the orbital floor, as this can affect the outcome of treatment and the risk of complications such as enophthalmos or restricted eye movement 1. In summary, the clinical significance of an orbital floor blowout fracture is substantial, and prompt evaluation and treatment are necessary to prevent long-term morbidity and mortality, and to improve the patient's quality of life. Key considerations in the management of orbital floor fractures include:
- Prompt evaluation and treatment to prevent long-term morbidity and mortality
- Thorough examination, including vision testing, refraction, and imaging studies
- Goals of treatment: eliminate diplopia, enlarge field of binocular single vision, restore proper eye function and aesthetics
- Timing of surgical repair: immediate, within 2 weeks, or delayed, depending on the individual patient's symptoms and anatomy
- Consideration of individual patient's anatomy and degree of concavity of the orbital floor to minimize the risk of complications.
From the Research
Clinical Significance of Orbital Floor Blowout Fractures
The clinical significance of an orbital floor blowout fracture can be understood by considering the following aspects:
- Symptoms and Complications: Orbital floor blowout fractures can lead to symptoms such as diplopia, enophthalmos, gaze restriction, and herniation of orbital tissues through gaps in the orbital floor bone 2, 3, 4, 5, 6.
- Surgical Treatment: Surgical treatment of orbital floor fractures can result in significant improvement in symptoms, with studies reporting decreases in diplopia, enophthalmos, and gaze restriction 2, 3, 4, 5, 6.
- Reconstruction Materials: Various materials can be used for orbital floor reconstruction, including resorbable and non-resorbable materials, such as titanium mesh, collagen membrane, and autologous bone graft 2, 3, 4, 5, 6.
- Surgical Approach: The choice of surgical approach can vary, with options including preseptal transconjunctival approach, subtarsal incision, and endoscopic endonasal transmaxillary approach 2, 3, 6.
- Timing of Surgery: The timing of surgical intervention can also impact outcomes, with some studies suggesting that delayed surgery may result in better outcomes in terms of diplopia and motility disturbances 2.
Treatment Outcomes
Treatment outcomes for orbital floor blowout fractures can be summarized as follows:
- Improvement in Symptoms: Studies have reported significant improvements in symptoms such as diplopia, enophthalmos, and gaze restriction following surgical treatment 2, 3, 4, 5, 6.
- Restoration of Orbital Function: Surgical treatment can also result in restoration of normal globe function and correction of enophthalmos and diplopia 6.
- Aesthetic Outcomes: Aesthetic outcomes can also be satisfactory, with studies reporting significant improvements in esthetic appearance and symmetry 5.