Optic Nerve Damage Complicating Repair of Orbital Floor Fracture

ABSTRACT

PURPOSE: The authors report a devastating complication, visual loss following the orbital wall fracture repair. Its occurrence results from orbital compartment syndrome, or direct intraoperative injury to the optic nerve from surgical manipulation, bony fragment, orbital implants, or inferior retinal arteriolar occlusion. METHODS: A patient who was 15-year old was fisted on his right eye. When he visited a hospital, both visual acuity was 1.0 and his pupillary light reflex was normal. He complained diplopia in primary position and his eyeball showed motility limitation to both upward and downward gaze. Anterior and posterior segments of the eye were normal. Orbital CT showed right inferior orbital wall fracture and herniated inferior rectus muscle sheath and soft tissue. Orbital floor implantation after systemic steroid therapy for 1 week was done. However postoperative visual acuity was decreased to light perception and relative afferent pupillary defect(RAPD) was developed. So immediately orbital decompression and mega-dose steroid therapy was carried out. RESULTS: After 2 month, visual acuity was recovered to 1.0 and RAPD was decreased. There remained hyperdeviation and exodeviation in right eye but was no limitation of eyeball movement. The color vision test was normal but visual field test, visual evoked potential test showed abnormal findings CONCLUSIONS: Visual loss following the repair of a orbital wall fracture was gradually recovered by immediate decompression and mega-dose steroid therapy but remained visual field defect associated with optic nerve atrophy.