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Juan Carlos Jiménez-Pérez, Michael K Yoon; Posterior Orbital Floor Fractures. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5142.
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© ARVO (1962-2015); The Authors (2016-present)
Orbital trapdoor fracture most commonly occurs in children but rarely is seen in adults. Entrapment with limitation of ocular motility occurs in patients of all ages. We will present a subtype of posterior orbital floor fracture (POF) with severe herniation of the inferior rectus causing poor motility.
A retrospective, comparative case series of patients with orbital floor fracture repair in a 5 year period by a single surgeon. Inclusion criteria were unilateral POF with inferior rectus herniation as seen in sagittal view of CT scan (Figure 1) and complete ophthalmologic examination. An equal case control group with similar demographics but without POF was identified for comparison. (Figure 2) Baseline characteristics, motility, time to surgery, post-operative findings, need for post-operative imaging, and need for reoperation were recorded.
In our series, nine patients with a mean age of 33 years were included, with a similar control group identified. Eight of 9 patients (89%) in the study group had symptomatic diplopia and EOM limitation on presentation versus (56%) in the control group. Time between trauma and surgery was approximately 9 days in the study group and 17 days in the control group. Following surgery, 56% in the study group had persistent EOM limitation compared to 11% in the control group. Three patients in the study group required imaging after surgery and one of those patients required a second surgery. None in the control group need imaging or re-operation.
POF with inferior rectus muscle herniation is an uncommon subtype of fracture that may be more readily visualized with the near ubiquity of sagittal reconstruction on CT scans. These patients had a higher percentage of pre- and post-operative EOM dysfunction when compared with the control group. Despite earlier intervention compared to the control group, the patients with POF had persistently worse outcomes and needed post-operative imaging and re-operation more frequently. We recommend immediate surgical repair once recognized, similar to pediatric trapdoor fractures.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Figure 1. Sagittal view of orbital CT scan showing POF with bowing of inferior rectus muscle.
Figure 2. Sagittal view of orbital CT scan showing POF without inferior rectus muscle herniation.
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