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Kang and Ha: A Clinical Feature of the Patients of Orbital Wall Fracture With Diplopia
Original Article

J Korean Ophthalmol Soc 2009;50(7):969-975.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.7.969

A Clinical Feature of the Patients of Orbital Wall Fracture With Diplopia

Hyo Jeong Kang, MD, Myung Sook Ha, MD

Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea

Address reprint requests to Myung Sook Ha, MD Department of Opthalmology, Konyang University Hospital #685 Gasoowon-dong, Seo-gu, Daejeon 302-718, Korea Tel: 82‐42‐600‐9258, Fax: 82-42-600-9176, E-mail: hmseye@hanmail.net

Received 5 June 2008       Accepted 10 March 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the clinical features of orbital wall fracture with diplopia between the surgical treatment group and the conservative treatment group.

Methods

The study comprised of 109 eyes of 109 patients with orbital wall fracture and diplopia. The patients were divided into two groups: the surgical treatment group (59 cases) and the conservative treatment group (50 cases). The groups were analyzed retrospectively according to age, gender, cause, CT, the period and severity of diplopia, and enophthalmos with time.

Results

In the conservative treatment group, 38 cases (64.4%) had medial wall fracture, and the average fracture size was 26% of the inferior wall and 33% of the medial wall. In addition, at the first visit, the patients showed diplopia within 45.5 degrees, and diplopia disappeared completely within 17 days on average (57 cases, 96.6%). In the group that underwent the reconstruction of orbital wall fracture, 27 cases (54.0%) had inferior wall fracture, and the average fracture size was 41% of the inferior wall and 35% of the medial wall. Additionally, in the first visit, the patients showed diplopia within 20.3 degrees. The muscle incarceration occurred in 12 cases (24%). In the surgical treatment group, diplopia disappeared completely within 30 days on average (45 cases, 90.0%).

Conclusion

In the group of conservative treatment, they showed diplopia within 45.5 degrees at the first visit. Diplopia disappeared completely within 17 days on average (57 cases, 96.6%). In the group of surgical treatment, they showed diplopia within 20.3 degrees at the first visit. Diplopia disappeared completely within 30 days on average (45 cases, 90.0%).

Keywords: Conservative treatment, Diplopia, Enophthalmos, Orbital wall fracture, Reconstruction

References

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Figure 1.
Cause of diplopia on the computed tomography of orbital wall fracture. (A) Soft tissue swelling, (B) Extraocular muscle swelling, (C) Soft tissue incarceration, (D) Extraocular muscle incarceration.
jkos-50-969f1.tif
Figure 2.
Number of patients with diplopia
jkos-50-969f2.tif
Table 1.
Sex and age distribution of orbital wall fracture
Surgical treatment Conservative treatment
Sex Male 44 (88%) 41 (69.5%) p=0.022*
(No.) Female 6 (12%) 18 (30.5%)
Age mean 28.8 36.1 p=0.022*
(years) ≤20 15 (30%) 9 (15.3)
21–40 26 (52%) 26 (44.1)
≥41 9 (18%) 24 (40.7%)

* Chi square test

No=number.

Table 2.
The characteristics of orbital wall fracture
Surgical treatment Conservative treatment
Cause of fracture Violence 18 (36%) 21 (35.6%) p=0.059*
(No) Traffic accident 5 (10%) 18 (30.5%)
Fall down 12 (24%) 12 (20.3%)
Projectile object 8 (16%) 3 (5.1%)
Sports, Working 6 (12%) 5 (8.5%)
Fracture site Inferior wall 27 (54%) 6 (10.2%) p<0.001*
(No) Medial wall 13 (26%) 38 (64.4%)
Inf & med wall 10 (20%) 15 (25.4%)
Size of fracture Inferior wall 41.5±15.0 26.2±9.6 p<0.01†
(%) Medial wall 35.9±15.5 34.0±9.4 p=0.51†

* Chi square test

† Independent sample t-test

No=number.

Table 3.
The characteristics of diplopia
Surgical treatment Conservative treatment
Degree of diplopia on 1 st visiit 20.3±17.4 45.5±9.0 p<0.001†
Cause of diplopia (No)‡ Soft tissue swelling 0 (0%) 37 (62.7%) p<0.001*
Muscle swelling 10 (20%) 10 (16.9%)
Soft tissue incarceration 28 (56%) 9 (15.3%)
Muscle incarceration 12 (24%) 0 (0%)
Muscle paralysis 0 (0%) 3 (5.1%)
Loss of diplopia (days) 30 17 p=0.009†

* Chi square test

† Independent sample t-test

‡ No=number

Table 4.
The clinical feature of diplopia according to cause
Cause of diplopia Patient (No†) Degree of diplopia on 1st visit(degree) Residual diplopia on (No/degree) Loss of diplopia (days)
Soft tissue swelling 37 45.68 0 (0.00%) 0 16.24
Muscle swelling 20 35.25 2 (10.0%) 35.00 16.03
Soft tissue incarceration 37 28.51 3 (8.1%) 38.33 34.58
Muscle incarceration 12 9.58 2 (16.7%) 22.50 39.62
Muscle paralysis 3 45.00 0 (0.0%) 0 8.05
Total 109 p=0.17*

* Chi square test (group of muscle incarceration vs other groups)

† No=number.

Table 5.
Enophthalmos of orbital wall fracture
Surgical treatment Conservative treatment
1 st visit (mm) 1.02±0.84 0.53±0.59 p=0.01*
6 month (mm) 0.88±0.75 0.52±0.52 p=0.04*
6 month-1 st visit (mm) −0.14±0.82 (p=0.23†) −0.17±0.62 (p=0.83†)

* Independent sample t-test

† Paired sample t-test (difference from 1 st visit and 6 months).

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