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Late surgery for orbital blowout fractures proves safe for younger patients
Br J Ophthalmol. 2010;94(6):736-739.
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Delayed surgery for orbital blowout fractures did not diminish outcomes in young patients, according to a study.
"Previous series suggest that significant delays between injury and surgery lead to poorer outcomes in young patients with orbital blowout fractures," the study authors said. "The data from this series show that despite delays, excellent outcomes can be obtained."
However, delayed surgery was associated with longer recovery time, the authors said.
The retrospective study included 19 patients with a mean age of 13 years.
Data showed that 74% of patients had minimal external soft tissue signs; 47% had vagal symptoms such as nausea, vomiting, extreme pain or drowsiness. Most patients with vagal symptoms (89%) presented within 72 hours of sustaining injury.
CT scanning showed that all patients had orbital floor fractures; 31.5% of these patients had linear fractures, 31.5% had open trapdoor fractures and 37% had depressed plate fractures.
The mean interval from injury to surgery was 14 days (range: 0 to 113 days). Sixty-eight percent of patients were assessed more than 3 days after sustaining injury.
Results showed no perioperative complications related to surgery or anesthesia. Improvements in preoperative duction deficits were seen in all patients. Nine patients were free of symptoms and signs at 1 month postop.
Three patients had minor diplopia in extreme gaze at final follow-up when surgery was performed within 1 week of injury. In cases in which surgery was performed later than 1 week after injury, results showed a greater incidence of extreme gaze diplopia. Most symptoms resolved within 2 months postop, the authors said.
This is a small series of patients that underwent surgery for orbital soft tissue entrapment following a blowout fracture of the orbit. Because the number of patients is limited and some had very little follow-up following surgery, the results discussed in the paper should be taken with some caution. However, it appears that a delay in surgery may not lead to a poorer outcome as has been suggested in the past. This may be especially useful information when treating patients with other related injuries when delaying surgery is needed or when significant swelling may make the clinical evaluation more difficult.
– Scott E. Olitsky, MD
OSN
Pediatrics/Strabismus Board Member
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