Abstract
Purpose :
Delaying repair of orbital fractures without muscle entrapment has recently been advocated in adults. Observation may result in recovery without a need for surgery, and outcomes following later surgery appear similar to earlier surgery. However, studies addressing this issue in children are limited. We sought to determine the preferred timing for orbital fracture repair in children.
Methods :
Retrospective cohort study of children with orbital fracture, classified into groups based on presence of entrapment and timing of repair. Early repair was defined as surgery within 3 weeks of injury. A successful clinical outcome was defined as absence of both enophthalmos and strabismus at latest follow-up. Presenting findings, including muscle entrapment, enophthalmos, motility restriction, and fracture size, were considered as potential confounding factors or indications for surgery.
Results :
We studied 147 children with orbital fracture (median age 12 years, range 0.2-18; median follow up 3.1 months, range 0.3-103). 11(7.5%) had entrapment and had surgery at median 1 day post-injury (range 0-15). Among 136 without entrapment, 30 had early repair (median 12.6 days, range 1-18) and 106 did not, of which 5 eventually had surgery (median 57 days, range 47-157) and 101 had no surgery. Successful outcomes were seen in 91% of children with entrapment, 93% of early repair, and 95% late/no repair (p=0.65). Success did not differ between early and late surgery (93% vs. 80%, p=0.38). Among 31 children with fracture size >50% and no entrapment, successful outcomes occurred in 19/21 (90.5%) with early surgery, 2/2 (100%) with late surgery, and 10/11 (91%) of children with no surgery. Among patients without entrapment, enophthalmos and motility limitation at baseline resolved without surgery in 6/8 (75%) and 9/10 (90%) cases, respectively.
Conclusions :
Muscle entrapment is an indication for urgent orbital fracture repair. Otherwise, pediatric orbital fractures without entrapment should be observed for 3 months or more, as many patients will eventually not require surgery, and early surgery does not appear to improve outcomes. Contrary to long-held belief, extraocular motility limitation without entrapment, enophthalmos, or fracture size >50% are not indications for early surgery, as motility limitation and enophthalmos may resolve without surgery in a majority of cases, even when fracture size is large.
This is a 2021 ARVO Annual Meeting abstract.