Page 118 - Advanced concepts in orbital wall fractures

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Chapter 6
the patients, the binocular single vision (BSV) scores and quality-of-life (QoL) scores were high in these groups.
In 75 % of the patients in the surgical group, surgery was performed between 2 and 3 weeks. Two patients were treated within a week due to early enophthalmos or seriously limited ductions. One patient had surgery after 3 months due to persisting pain, which was believed to be related to infraorbital nerve dysesthesia.
The difference between excellent and good outcome was the presence of minor complications or sequelae. In the nonsurgical group infraorbital nerve hypesthesia, pain, and/or epiphora were recorded, while some in the surgical group experienced infraorbital nerve hypesthesia, pain, elevated intraocular pressure, and mydriasis. None of the complications led to impaired vision. The percentages of those complications or sequelae were comparable to other studies18,24,50.
The strength of this prospective research included the systematic and objective orthoptic evaluations in follow-up, and the use of various parameters to evaluate the surgical and nonsurgical results - both objective and subjective. Across the complete cohort 13 patients had residual diplopia, yet in only eight patients (three nonsurgical/five surgical) did this affect their daily activities, based on the QoL score. This difference between objective and subjective outcomes was also reported by Dietz et al.51. Patients seem to become accustomed to diplopia in extreme gaze, which may gradually decrease impairment over several months. The QoL score improved the most in the nonsurgical group, between 2 weeks and 3 months follow-up. In the nonsurgical group, the BSV score was high at the end of follow-up. These results confirm the outcome of other studies propagating nonsurgical management6,22,37.
In the surgical group, the BSV scores could still be considered acceptable to high (Alhamdani et al., 2015). Although none of the patients had diplopia in central gaze and 30 degrees in every direction, daily activities were partially limited in several patients. In most cases it was in extreme upward and downward gaze, with the downward limitation considered