Postoperative Diplopia and Enophthalmos After Orbital Fracture Repair
Shivani Kamat MD, Hajirah Saeed MD, Philip Lieu MD, Bruce Gaynes OD, Pharm D, Geeta Been MD
Loyola University Medical Center - Department of Ophthalmology - Maywood, Illinois
Background
Orbital fractures are common sequelae of periorbital blunt
trauma that can require surgical repair. The main long-term
sequelae of orbital fracture include development of
diplopia, which can reduce visual function, and
enophthalmos, which has significant effect on facial
cosmesis. However, despite the large volume of orbital
fracture surgery that is performed each year, the overall
incidence of postoperative diplopia and enophthalmos are
not clear. By quantifying the incidence of these
postoperative findings, patients can be counseled more
accurately about these potential sequelae of operative
repair and have more realistic preoperative expectations.
Methods
We performed a literature search on MEDLINE for studies
published between 1998 and 2012 reporting the incidence
of diplopia and/or enophthalmos after surgical orbital
fracture repair. There was no restriction on surgical
technique. Search terms included ‘orbital fracture repair,’
‘diplopia,’ and ‘enophthalmos.’ Therefore, 10 studies were
selected using these criteria, on which a meta-analysis was
then performed.
Results
The meta-analysis included a total of 516 eyes undergoing
orbital fracture repair, with a mean of 46.9 patients per study.
The overall incidence of postoperative diplopia was 19%,
(range 0-35%). The overall incidence of postoperative
enophthalmos was 16%, (range 0-26%).
Endonasal repair: i, inferior turbinate; m, middle turbinate; M, maxillary sinus; S, septum. Hinohira Y, et al. Endoscopic Endonasal Reduction of
Blowout Fractures of the Orbital Floor. American Academy of Otolaryngology–Head and Neck Surgery, New York, NY, September 19-22, 2004.
Discussion
Table 1 – Incidence of Diplopia on Meta-Analysis
Study
Aitasalo
Buchel
Ducic
Hosal
Hundepool [open repair]
Hundepool [endoscopic]
Jin
Kempster
Lee
Nahlieli
Otori
Totals
Diplopia
Eyes
Incidence
2
3
0
7
18
4
29
1
0
0
18
14
87
63
42
58
25
84
4
41
10
88
14%
3%
0%
17%
31%
16%
35%
25%
0%
0%
20%
77
415
19%
 Surgical indications for repair of orbital fractures is fairly
common
 Case series with reported outcomes in the primary
literature are relatively uncommon
 The overall incidence of postoperative diplopia was 19%
but ranged from 0-35% depending on the study
 The overall incidence of postoperative enophthalmos was
16% but ranged from 0-26%
 Multiple variances in surgical approach, technique, and
clinical presentation likely account for the large range of
reported incidence
 It is important to counsel patients about the risk of
diplopia or enophthalmos when discussed surgical repair
of orbital fractures for realistic patient expectations
References
Table 2 – Incidence of Enophthalmos on Meta-Analysis
Study
Enophthalmos
Eyes
Incidence
Aitasalo
Buchel
Hosal
Hundepool open repair
Hundepool endoscopic repair
Lee
Nahlieli
1
2
3
15
3
2
0
14
87
42
58
25
10
10
7%
2%
7%
26%
12%
20%
0%
23
145
16%
Totals
Transconjunctival repair. Lane KA, et al. “Sutureless” Repair of Orbital Floor and Rim Fractures.
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Acknowledgements:
Research supported by the Richard A. Perritt Charitable Foundation.