Orbital Implants in Orbital Fracture Reconstruction: A Ten-Year Series.

STUDY DESIGN: Retrospective comparative interventional series of all patients who had undergone orbital fracture repair by 2 senior orbital surgeons in a single tertiary trauma center from January 2005 to December 2014. OBJECTIVE: To compare the outcomes of different implants used for various types of orbital fractures. METHODS: Patients were evaluated by age, gender, etiology of fracture, clinical findings, type of fractures, and implant used. Main outcome measures included restoration of premorbid state without morbidity and complications including enophthalmos, diplopia, infraorbital hypoesthesia, and ocular motility restriction 1 year after fracture repair. Implant-related complications were collected for analysis. RESULTS: There were a total of 274 patients with 307 orbits reconstructed. Thirty-three (12.0%) patients sustained bilateral injuries; 58.0% (n = 178) of orbits had simple fractures (isolated orbital floor, medial wall, or combined floor and medial wall). The distribution of implants used were bioresorbable (n = 117, 38.1%) and prefabricated titanium plates (n = 98, 31.9%) depending upon the nature of fracture. Bioresorbables, titanium plate, and porous polyethylene were used significantly more than titanium mesh for simple fractures, and prefabricated anatomic titanium implants were used significantly more than the other implants for complex fractures. There was a statistically significant improvement in diplopia, enophthalmos, ocular motility, and infraorbital hypoesthesia (p-value < 0.001) 1 year following orbital fracture reconstruction. CONCLUSIONS: When used appropriately, diverse alloplastic materials used in orbital fracture repair tailored to the indication aid orbital reconstruction outcomes with each material having its own unique characteristics.

Incidence and Risk Factors of Inferior Rectus Muscle Palsy in Pediatric Orbital Blowout Fractures.

The aim of this study was to evaluate the incidence, clinical features, and risk factors of sustaining inferior rectus (IR) palsy in a group of pediatric patients with orbital floor blowout fractures. We performed a retrospective case review of sequential cases of pediatric orbital floor blowout fractures (<18 years old) from 2000 to 2013 in a tertiary ophthalmic center in Singapore. A total of 48 patients were included in our study, of whom 5 had IR palsy (10.4%). Patients with IR palsy had a higher mean age (16.4 ± 1.5 years) compared with patients without IR palsy (12.4 ±3.3 years), had significantly ( p < 0.05) worse preoperative motility, and had significantly greater proportion developing postoperative hypertropia (100%) compared with patients without IR palsy (4.7%). Our series of pediatric blowout fractures demonstrated IR palsy prevalence and clinical features for IR palsy which may be distinct to the pediatric group.

Permanent Versus Bioresorbable Implants in Orbital Floor Blowout Fractures.

PURPOSE: To compare the outcomes of bioresorbable and permanent implants in the reconstruction of isolated orbital floor blowout fractures. METHODS: Retrospective series of all patients who had orbital floor fracture repair in a single tertiary trauma center from January 2005 to December 2014. The authors reviewed the case notes and CT scans of patients with orbital floor fracture repair with either bioresorbable or permanent implants. Main outcome measures were enophthalmos, diplopia, and ocular motility restriction 1.5 years after fracture repair. Implant-related complications were collected for analysis. RESULTS: There were a total of 88 patients in our study. Bioresorbable implants were used in 48 patients (54.5%) while 40 patients had permanent implants (45.5%). The authors analyzed the implants used in various sizes of orbital fractures: small (<13.3 mm), medium (13.3-20 mm), and large (>20 mm). One and a half years after fracture repair, both groups had comparable clinical outcomes (n = 2 and n = 0 for diplopia for permanent and bioresorbable implant groups, respectively, n = 0 for enophthalmos for both groups and n = 1 for ocular motility limitation for both groups) overall and across all fracture sizes. CONCLUSION: Bioresorbable implants degrade after fracture healing through hydrolysis and promote the gradual transfer of functional forces to healing bone during its disintegration. The clinical outcomes of diplopia, enophthalmos, and ocular motility restriction associated with the use of resorbable implants are comparable to that of permanent implants for all fracture sizes. Their study shows that bioresorbable and permanent implants are equally safe and effective for the treatment of patients with isolated orbital floor blowout fractures.

A study of sports-related orbital fractures in Singapore.

With an increased popularity of sport and active living worldwide, our study aims to explore the incidence and features of sports-related orbital fractures in Singapore. 1421 computer tomography (CT) imaging scans of the face and orbits done at the National University Hospital over a 24-month period from January 2013 and December 2014 were reviewed retrospectively for orbital fractures. We identified 483 orbital fractures of which sports injury was the fourth most common etiology (n = 65; 13.5%) after road traffic accident (n = 131; 27.1%), geriatric fall (n = 81; 16.8%) and workplace injury (n = 67; 13.9%). The three most common sport in orbital fractures were soccer (n = 20; 30.8%), bicycling (n = 11; 16.9%) and jogging (n = 8; 12.3%). The three most common fracture patterns were zygomatico-maxillary complex fractures (n = 24; 36.9%), isolated one wall blowout fractures (n = 19; 29.2%) and naso-orbito-ethmoid fractures (n = 7; 10.8%). Sports-related orbital fractures were associated with a low mean age of patients (45.9 years, range, 14-79 years), a higher proportion of males (n = 58; 89.2%) than that from geriatric falls (n = 37, 45.6%) (P < 0.01), a higher likelihood of unilaterality (n = 62; 95.4%) than that from traffic accidents (n = 99; 75.6%) (P < 0.01) and a lower likelihood of pan-facial involvement (n = 4; 6.15%) than that from traffic accident (n = 60; 45.8%) (P < 0.01). Sports-related orbital fractures are the fourth most common cause of orbital fractures. Though commonly seen in young male adults, in view of the aging population and people exercising more regularly, education of safety measures among sports users is paramount to preventing sports-related orbital fractures.

Ophthalmic involvement in nasopharyngeal carcinoma.

This article desribes the ophthalmic involvement in patients with nasopharyngeal carcinoma (NPC) pre- and post-treatment. We retrospectively reviewed data for 354 consecutive patients diagnosed with or treated for NPC at a single tertiary centre between April 2007 and July 2015. We identified 27 (7.6%) patients with ophthalmic involvement due to NPC or its treatment. Symptomatic orbital invasion by tumor occurred in 13 of 27 patients (48.1%). The mean age of diagnosis in these patients was 54 years, and 8 (61.5%) had no prior diagnosis of NPC. Ocular signs, but no orbital invasion, was present in 8 patients (29.6%). Incidental orbital involvement was detected on imaging in 2 patients (7.4%). Radiotherapy-related ocular complications affected 4 patients (14.8%). Ophthalmic symptoms from orbital invasion can be the initial presentation of NPC. This disease tends to affect a younger group of patients and early recognition is important to minimize morbidity and mortality.

Use of bioresorbable implants for orbital fracture reconstruction.

PURPOSE: Bioresorbable implants offer several advantages over permanent implants and serve as a useful alternative in the reconstruction of orbital fractures. Our aim of the study was to evaluate the clinical effectiveness and safety of various bioresorbable implants in the repair of orbital fractures. METHODS: A retrospective review of all patients who had undergone orbital fracture repair with bioresorbable implants in a single tertiary trauma centre from January 2005 to December 2014 was performed. Main outcome measures included improvement in ocular motility, diplopia, enophthalmos and infraorbital hypoaesthesia, as well as complication rates. RESULTS: Our study comprised 94 patients and 98 orbits. The types of fractures included orbital floor blow-out fractures (56.1%), zygomaticomaxillary complex fractures (20.4%), combined orbital floor and medial wall fractures (15.3%) and medial wall blow-out fractures (5.1%). The implants evaluated included poly-L/DL-lactide implants (P[L/DL]LA) 85/15 (Rapidsorb), (P[L/DL]LA) 70/30 (PolyMax), polycaprolactone (Osteomesh) and (P[L/DL]LA) 70/30 (MacroPore). There was significant improvement in ocular motility, diplopia, enophthalmos and infraorbital hypoaesthesia postoperatively at week 1, 1 month and 6 months (p<0.001). Comparison of results between the various implants and types of fractures showed no significant difference in postoperative outcome and complications. Late postoperative imaging at 15-24 months showed complete resorption of implants and features of neobone formation in all patients. CONCLUSION: Our experience with bioresorbable implants shows them to be safe and clinically effective in the reconstruction of orbital fractures.

A Review of Eyelid Margin Malpositions: A Unique Spectrum in a South-East Asian Tertiary Hospital.

PURPOSE: Due to the anatomical differences between the Asian and non-Asian eyelid, the authors hypothesize a different spectrum of eyelid margin malposition conditions seen in Singapore as compared with a predominant Caucasian population. The purpose of the study is to describe the spectrum of eyelid margin malpositions that were operated in a South-East Asian Tertiary Hospital. METHODS: Retrospective study involving all patients who required surgery for eyelid margin malpositions over a 2-year period. The etiology and ethnic spread of patients were analyzed for each eyelid margin malposition. RESULTS: A total of 249 eyelids (144 patients) were analyzed. There were 127 Chinese (88.2%), 8 Malays (5.6%), 6 Indians (4.2%), 2 Indonesians (1.4%), and 1 Korean (0.7%). Epiblepharon (53.4%) was the commonest surgery performed, followed by entropion (25.7%) and ectropion (20.9%). Among patients with epiblepharon and entropion, Chinese patients formed the overwhelming majority (>95%). There were no Eurasians or Indians who presented with epiblepharon or entropion. Among patients with ectropion, there was a higher representation of Indian patients (16.7%). CONCLUSIONS: This study shows that the spectrum of eyelid margin malpositions in Singapore is unique and that developmental epiblepharon remains the commonest eyelid margin malposition requiring surgery. In terms of involutional eyelid margin malpositions, entropion is more common than ectropion, especially among the Chinese. The similarity in terms of eyelid involvement and ethnic distribution of both epiblepharon and involutional entropion suggests that there is a common factor in both these conditions, which the authors infer is due to the unique anatomy of the Asian eyelid.

Thyroid eye disease: a Southeast Asian experience.

AIM: To study the demographics, comorbidities, clinical manifestations and treatment methods of thyroid eye disease (TED) in Singapore. METHODS: In this retrospective case series, we analysed the case records of all patients with TED who presented at our multidisciplinary Thyroid Eye Clinic from November 2002 to October 2012. RESULTS: There were a total of 174 patients-111 female patients (63.8%) and 63 male patients (36.2%). The majority of the patients were ethnically Chinese (80.5%), followed by Malay (10.3%) and Indian (6.3%). The mean age was 40.2 years (SD±15.5, range 0.3-87.0). The commonest sign on ophthalmic examination was eyelid retraction (62.1%), followed by proptosis (61.0%) and lid lag (57.5). Acquired epiblepharon and corneal erosions were noted in 11.5% and 29.3% respectively. Eight patients (4.6%) had dysthyroid optic neuropathy. The mean exophthalmometry reading was 18.8 mm (SD±3.32, range 10.0-28.0). Mild, moderate and severe disease was noted in 71.3%, 20.7% and 8.0% respectively. Thyroid dysfunction was managed with anti-thyroid medication only (40.2%), ß blockers (19.5%), thyroxine replacement (14.4%), radioactive iodine (14.4%) and block-replace regime (9.8%). Clinically significant active orbitopathy was managed with intravenous corticosteroids (12.1%). Surgical procedures consisted of thyroidectomy (10.3%), eyelid surgery (8.6%), orbital decompression (7.5%), epiblepharon correction (2.3%) and strabismus surgery (0.6%). CONCLUSIONS: Corneal erosion secondary to acquired epiblepharon is a common sign in East Asian patients with TED, thus increased awareness among physicians should be encouraged. Mean exophthalmometry values and frequencies of upper eyelid retraction and oedema are lower in East Asian patients compared with Caucasian patients. Among Singapore's multi-ethnic population, Malay patients with TED had the highest exophthalmometry reading.

Comparison of incidence of ptosis after combined phacotrabeculectomy with mitomycin C and phacoemulsification.

OBJECTIVE: To compare the incidence of upper eyelid blepharoptosis after combined phacotrabeculectomy with mitomycin C and phacoemulsification surgeries and the relationship of bleb morphology to the incidence of ptosis. DESIGN: Retrospective observation study. PARTICIPANTS: We included 46 patients after combined phacotrabeculectomy and 44 patients with phacoemulsification in the former group, and all eyes underwent a standardized two-site surgery with intra-operative mitomycin C. MATERIALS AND METHODS: Postoperative ptosis was defined as a reduction of upper marginal reflex distance 2 mm in the operated eye compared to the fellow eye. Trabeculectomy bleb measurements were carried out using anterior segment optical coherence tomography (Visante™, Carl Zeiss Meditec, Dublin, CA, USA) which included bleb height and total area of the bleb. RESULTS: There were 8 eyes (17.4%) and 5 eyes (11.4%) with postoperative ptosis in the phacotrabeculectomy and phacoemulsification groups, respectively (P = 0.342). In multivariate regression analysis, reduced total bleb area was significantly associated with upper eyelid ptosis after adjusting for age, gender, and type of anesthesia. The trend seemed to show that increased bleb height was also associated with ptosis, but this did not reach statistical significance. CONCLUSIONS: Incidence of persistent ptosis after phacoemulsification combined with trabeculectomy and mitomycin C is similar compared to stand alone phacoemulsification surgery in a multiethnic Asian population. Bleb morphology may play an important role in postoperative ptosis development and should be considered in the evaluation of upper eyelid blepharoptosis.

Assessment of bony nasolacrimal parameters among Asians.

PURPOSE: A case series evaluating racial differences in the nasolacrimal region and quantifying the anterior lacrimal crest thickness and minimum nasolacrimal duct diameter in Asians. METHODS: Facial or orbital CT scans of 90 consecutive patients were retrospectively reviewed. Evidence of lacrimal fossa tumor or trauma excluded a patient. Using 3-dimensional image software, the thickness of the anterior lacrimal crest, narrowest diameter of the nasolacrimal duct, vertical diameter of the lacrimal sac fossa, frontonasal angle, and inter-frontozygomatic suture distance were measured in axial, sagittal, and coronal planes. RESULTS: Inter- and intraobserver correlation of a sample data proved reliability via intraclass correlation coefficient (0.706-0.917). Southeast Asians had a wider inter-frontozygomatic suture distance than South Asian and Occidental races (p = 0.025). Vertical lacrimal fossa diameter, anterior lacrimal crest thickness, and narrowest nasolacrimal duct diameter did not differ significantly between right and left sides or among ethnic groups. Narrower nasolacrimal duct diameter was significantly associated with decreased inter-frontozygomatic suture distance (p < 0.001), namely in patients with narrower faces. The anterior lacrimal crest thickness was significantly affected by the nasal configuration and thicker in patients with more acute frontonasal angle (p = 0.026). CONCLUSIONS: There is no significant difference in nasolacrimal duct diameter among ethnic groups, which may predispose one to nasolacrimal duct obstruction. But, this is significantly associated with inter-frontozygomatic suture distance, suggesting that a wider face is associated with wider nasolacrimal duct diameter. An acute frontonasal angle predicts a thicker anterior lacrimal crest for surgical preparation during dacryocystorhinostomy.

Pediatric thyroid eye disease--the Singapore experience.

PURPOSE: To identify the demographics, risk factors, clinical manifestations and treatment methods of pediatric thyroid eye disease (TED) in a South-East Asian tertiary referral practice. METHODS: Retrospective case series of all pediatric patients (aged 18 years and under) who presented to our TED clinic between Jan 2006 and Dec 2012. RESULTS: Thirteen patients (26 eyes) were identified - 8 females (61.5%) and 5 males (38.5%), accounting for 6.2% of all TED patients in our practice. Median age was 10.0 years (range, 0.3-18.0). Positive family history was noted in 9 patients (69.2%) and there were no active/passive smokers. Mean follow-up duration was 1.81 years (range, 0-5.2). Common presenting signs included proptosis (92.3%), eyelid retraction (84.6%), acquired epiblepharon (69.2%), corneal erosion (53.8%), and lagophthalmos (53.8%). None had optic neuropathy or strabismus. Mean exophthalmometry was 17.8 mm (SD ± 3.6 mm, range 13.0-27.0). Ten patients (76.9%) had mild disease, 3 patients (23.1%) had moderate disease and none had severe disease. Clinically significant Active disease as defined in adults (VISA Inflammatory Score >4/10), was not observed in any patient. The majority of the patients were treated conservatively. One patient underwent bilateral orbital decompression for severe proptosis, while two patients underwent bilateral lower epiblepharon correction with good outcomes. None required corticosteroids (oral/pulsed). CONCLUSION: Clinical manifestations in pediatric TED are relatively mild and respond well to conservative therapy. Orbital decompression is rarely required but may be considered in children with severe proptosis. Mean exophthalmometry values are lower in East-Asian pediatric TED as compared to Caucasians. Symptomatic acquired epiblepharon, usually associated with keratopathy, is commonly seen in East-Asian pediatric TED; thus, increased awareness among ophthalmologists and pediatricians should be emphasized.

Periorbital necrotizing fasciitis -- a review.

Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft-tissue defects affecting function and cosmesis.

Declining incidence of eyelid cancers in Singapore over 13 years: population-based data from 1996 to 2008.

PURPOSE: To describe the epidemiology and trends in eyelid malignancies in Singapore from 1996 to 2008. METHODS: The Singapore Cancer Registry has been collecting epidemiological data of all cancers seen in Singapore since 1968. Data of all eyelid cancers from 1996 to 2008 were retrieved for analysis. The age-standardised incidence rates and age-specific incidence rates were calculated with the direct method, using the 2000 world population as a standard. RESULTS: There were a total of 160 male patients (48%) and 173 female patients (52%). The median age at diagnosis was 66 years (range 31-95) for male subjects and 67 years (35-99) for female subjects. The average annual age-standardised incidence rate of all eyelid cancers over the 13 years was 5.0 per million. A significant decrease in rates from 6.6 per million in the 1996-1998 period to 3.9 per million in the 2005-2008 period with an annual percentage change of 3.6% (95% CI -6.5 to 0.7%; p=0.02) was noted for women. The most common cancer was basal cell carcinoma (82%), followed by sebaceous gland carcinoma (11%) and squamous cell carcinoma (4%). CONCLUSIONS: The annual age-standardised incidence rates for male and female residents showed a steady decline over the last 13 years. These data suggest that factors related to sun protection have resulted in reduced eyelid cancers over time and provide a basis for such public health programmes elsewhere.

Epidemiology of oculoplastic conditions: the Singapore experience.

PURPOSE: To study the prevalence of eyelid, lacrimal, orbital conditions in an outpatient and surgical environment in a tertiary care hospital in Singapore. METHODS: An 8-month study was conducted in the Oculoplastics Department at the National University Health System (NUHS). Demographic data, diagnosis details and surgical records were compared. RESULTS: Of 623 patients seen over 906 visits, prevalence was as follows: eyelid (60.3%), orbital (20.6%), lacrimal (16.3%), dysthyroid exophthalmos (6.0%). Sixty-two (10.0%) patients had more than one condition. The most common conditions encountered included blepharoptosis, lacrimal obstruction, and orbital deformities (including fractures). During the same period, distribution of surgical procedures was as follows: eyelid (77.4%), lacrimal (13.1%) and orbit (9.5%). Interestingly, epiblepharon correction comprised 9.5% of the clinical/surgical cases. CONCLUSIONS: Although eyelid related conditions are most common, lacrimal and orbital pathologies cause significant morbidity. Oculoplastics specialists and ophthalmologists should consider placing more emphasis on surgical training specific to such conditions. We also propose separate classifications for epiblepharon and thyroid eye disease in the International Classification of Diseases (ICD) as they are unique clinical problems in their own right. A postoperative status will also help efficiently classify patients as such patients are at risk for related complications subsequently. An examination of healthcare budget allocation for such conditions is also suggested.

Mitochondrial Changes in Aging Orbicularis Oculi Muscles: Histologic and Genetic Analyses in Elderly Asian Patients.

PURPOSE: We aimed to determine whether there was underlying mitochondrial myopathy in some aging patients diagnosed with involutional ptosis. We compared orbicularis oculi muscle from patients with ptosis and patients with dermatochalasis without ptosis, using histochemical and mitochondrial DNA (mtDNA) analysis. DESIGN: This was a case-control study. METHODS: We studied 10 patients with ptosis who underwent correction surgery, and 10 patients without ptosis, who had dermatochalasis surgery, all in 1 institution. Orbicularis oculi muscle was examined with standard muscle histochemistry; modified Gomori trichrome, nicotinamide adenine dinucleotide (NADH), succinyl dehydrogenase (SDH), cytochrome c oxidase (COX), and Congo red. Genetic analysis was performed for deletions of mtDNA. RESULTS: The mean age of the group with ptosis was 67.6 years and that of the dermatochalasis group was 65.2 years. Inflammation, fibrosis, or amyloid was not present in the orbicularis of either ptosis or dermatochalasis group. There was no significant difference in ragged red fibers, NADH, SDH, or COX staining patterns between ptosis and dermatochalasis groups. One of 10 specimens in the ptosis group and 1 of 10 in the dermatochalasis group showed deletion of mtDNA. CONCLUSIONS: Our study of orbicularis oculi muscle found no difference between patients with and without involutional ptosis. We conclude that the presence of ragged red fibers, subsarcolemmal NADH and SDH accentuation, and COX-negative staining patterns in orbicularis muscle could represent age-related involutional changes. The significance of deletion of mtDNA needs further investigation.

Pediatric Orbital Blow-Out Fractures: Surgical Outcomes.

PURPOSE: The objective of this study was to evaluate the features, timing of intervention, complications, and outcomes of patients who underwent surgery for pediatric orbital blow-out fractures. DESIGN: This was a retrospective case review studying all cases of pediatric orbital blow-out fractures that underwent surgical intervention from 2000 to 2009 in a tertiary ophthalmic center in Singapore. METHODS: Case notes review of all cases of pediatric orbital blow-out fractures repaired surgically was carried out for demographics, time to intervention, and outcome. How the various factors may affect the outcome was statistically analyzed. RESULTS: A total of 23 patients were reviewed. There were 21 patients (91.3%) with floor fractures, 1 (4.3%) with medial wall fracture, and 1 (4.3%) with combined medial wall and floor fracture. Of the 21 cases of floor fracture, 20 cases had radiological images available for review, 17 (85%) were linear, and 3 (15%) were open. Patients with open fractures were older with a mean age of 14.0 years as compared with 12.6 years in those with linear fractures. The mean duration from injury to intervention was 13.0 days. Preoperatively, 14 (60.9%) had diplopia, but only 4 cases (17.4%) had diplopia in extreme gaze at the last follow-up after surgery (18 months). Outcome was not affected by age, duration between injury and intervention, type of fracture, and nature of implants used. CONCLUSIONS: Our study demonstrated that pediatric orbital blow-out fractures had good outcomes. It might also suggest the possibility of not having to manage all linear fractures as a surgical emergency.

Radiological signs of periorbital trauma - the Singapore experience.

PURPOSE: To describe the radiological signs and demographic characteristics of patients who suffered facial trauma in South-East Asia. MATERIALS AND METHODS: This is a retrospective cross-sectional study of a 399 patients who presented with facial trauma over a 2-year period in a tertiary referral centre in South-East Asia. Patients with available CT scan films were included. Demographics, bony and soft tissue radiology characteristics were analyzed. RESULTS: Male to female ratio was 320 (80%):79 (20%). Most of the facial trauma was due to Road Traffic Accident. Of 399 patients, 273 (68%) showed radiological signs of bone or soft tissue trauma. Of these 273 patients, left to right side involvement was 114 (41.7%) / 82 (30.03%), and 77 (28.2%) had bilateral involvement. Floor was the most involved wall (229[83.8%]) and the most involved rim was the inferior rim (164[60.07%]). There were 39 (14.2%) patients with blowout fracture. Bony nasolacrimal duct was broken in 56 (20.5%) patients. Optic canal fracture was found in 7 (2.5%) patients and it was associated with roof and superior rim fracture (P-values were 0.016, 0.046, respectively). Thirty-three (12.08%) patients had radiological signs of extraocular muscle involvement. Traumatic intracranial signs were associated with roof and superior rim fractures (P < 0.001 for both). CONCLUSION: Floor and inferior rim were the most affected orbital structures in facial trauma. We described radiological risk factors association with optic canal, NLD fracture and intracranial involvement. We described extraocular muscle morphological signs, which could alert to the possibility of orbital floor fracture in equivocal cases.