Does Preoperative Diplopia Determine the Incidence of Postoperative Diplopia After Repair of Orbital Floor Fracture? An Institutional Review.

PURPOSE: The purpose of our study was to investigate whether the occurrence of preoperative diplopia determines the incidence of postoperative diplopia after orbital floor repair. MATERIALS AND METHODS: We undertook a retrospective cohort study with a review of the records of 126 consecutive patients who had undergone repair of an orbital floor fracture under the maxillofacial surgery service at John Hunter Hospital (Newcastle, NSW, Australia). The primary predictor variables were a number of demographic, etiologic, and operative factors that might influence the occurrence of diplopia. The secondary outcome variable was diplopia. A descriptive statistical analysis was used to assess each of these variables and their potential relationship to the occurrence of diplopia. RESULTS: Of the 126 patients included in our study, 84 (66.6%) were treated for diplopia and 42 (33.3%) for dystopia. We found that orbital exploration and repair, when undertaken to manage diplopia, can resolve (75%), improve (7.14%), stabilize (7.14%), or worsen (10.71%) diplopia. In contrast, orbital surgery to manage or prevent dystopia can, in our experience, induce diplopia in 9.52% of patients. At the 95% confidence interval, age was the only variable shown to be significantly associated with diplopia (P = .039). We found that the presence of preoperative diplopia is causally statistically associated with postoperative diplopia at the 90% confidence interval (P = .063). CONCLUSIONS: Diplopia is a common occurrence that results from orbital floor fracture. It can resolve, persist (improve, remain stable, or worsen), or be induced after repair of such an injury. In addition to the known myogenic cause (entrapment) of diplopia, both trauma and surgical manipulation have been shown to have the capacity to compromise ocular motor nerve function and possibly result in the development of neurogenic causes of diplopia. It has also been noted that several intraorbital adherence syndromes can potentially contribute to the development of diplopia. This is an area that requires further research.

Infective endocarditis in a patient with atopic dermatitis.

We present the case of a 39-year-old plumber who was diagnosed with infective endocarditis due to Staphylococcus aureus. The route of entry was attributed to the patient scratching pruritic lesions of his poorly controlled atopic dermatitis (eczema). We recommend that medical practitioners of patients with poorly controlled atopic dermatitis should pay particular attention to, and take measures to mitigate against, this risk. .