Page 106 - Advanced concepts in orbital wall fractures

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Chapter 6
of less than 15 degrees or abduction less than 25 degrees was an indication for early surgery (<2 weeks)40. Defect size alone, in absence of enophthalmos, was no indication for surgery. Patients were advised to perform monocular orthoptic exercises three times a day for the first week. Patients without all above-mentioned criteria were placed in the nonsurgical group (Fig. 1).
Nonsurgical group
For the nonsurgical group, a control visit was scheduled within 10-14 days. Clinical, ophthalmic and orthoptic examination were repeated, including a diplopia quality-of-life (QoL) questionnaire. Patients were transferred to the surgical group if significant enophthalmos (>2 mm) had developed or ductions and diplopia showed a limited improvement. Improvement was defined as binocular single vision in primary gaze and improvement of duction of >8 degrees in the most limited position. If orthoptic examination was not performed in the first week (e.g. due to swelling), it was impossible to measure improvement. Therefore, a limitation in elevation of less than 15 degrees or abduction less than 25 degrees after 2 weeks was an indication to perform surgery. A bony reconstruction was performed within 7 days. In all other cases, the patient would remain in the nonsurgical group.
Three months (± 7 days), 6 months (± 14 days), and 12 months (± 14 days) after first presentation, follow-up visits were scheduled for clinical, ophthalmologic, and orthoptic examination, and the QoL questionnaire. Limiting diplopia and ductions or enophthalmos >2 mm were late indications to transfer to the surgical group. Some rare sequelae (e.g. persistent pain) were also considered for surgery.