Clinical Analysis of Internal Orbital Fractures in Children

In order to describe the demographics, etiologic and clinical factors, and outcomes of orbital fractures in children, we have reviewed a case series of 17 patients under 18 years of age with internal orbital fractures (i.e., without involvement of the orbital rim) presenting to the Ghil hospital between March 2000 and June 2001. For 15 of the patients, we performed orbital wall reconstruction with Medpor (R) barrier sheet implantation (thickness 1mm) through transconjunctival approach under endoscopic guidance, while maintaining mere observation on the other 2 patients. There were 14 male and 3 female patients. The most common cause of fractures was accident (7 cases). Inferior wall involvement was most commonly seen, and the trapdoor type fracture was the most common. Thirteen patients had extraocular muscle restriction, 9 had nausea/vomiting and 5 had bradycardia. Diplopia of 9 patients disappeared after 43+/-23 days. Nausea/vomiting and bradycardia disappeared rapidly after surgical intervention in all cases. These results suggest that trapdoor fractures with soft tissue entrapment are the most common in pediatric orbital wall fractures, and that most of them are associated with nausea/vomiting. We suggest that early diagnosis, and prompt surgical intervention are required for those patients with oculocardiac reflex.

Clinical Analysis of the Size of the Orbital Implant and Prosthesis in Eviscerated Patients

PURPOSE: This study evaluated whether the axial length of the fellow eye measured by A-scan biometry can be utilized for selecting the proper size of the orbital implant. METHODS: Thirty four eyes of 34 adult patients who had undergone eviscerations between March 2000 and May 2002 were included. We measured the axial length of the fellow eyes by A-scan preoperatively. Postoperatively, the central thickness and volume of ocular prosthesis were measured to determine the ideal size of prosthesis. RESULTS: Average diameter of the fellow eyes was 22.6mm. Average difference in diameter between the fellow eyes and orbital implants was 1.8mm among eyes with 20-22 mm in adults, and 3.8mm among eyes with 22-24mm. Average central thickness of the ocular prosthesis was 6.47 mm, and average volume was 2.2 ml. Complications occurred in 4 cases, and 2 of those cases were corrected by operations. CONCLUSIONS: Preoperative measurement of the diameter of the fellow eye using A-scan ultrasonography can be useful in selecting the size of the orbital implant before evisceration in adult patients. It also helped the selection of the proper sized ocular prosthesis and the prevention of many postoperative complications.