Management of Eye Trauma for the Primary Care Physician.

Eye trauma is frequently seen by non-ophthalmology providers. This article elucidates a methodological approach to eye trauma. The first step is to address any life-threatening conditions. Then a focused history and exam is discussed, starting externally. Then, key history, physical, pathophysiology, and basic management of common, serious eye injuries are discussed: chemical injury, orbital fractures, open globe, traumatic hyphema, retinal detachment, traumatic optic neuropathy, and eyelid laceration. Finally, we highlight the practicality of telemedicine for areas where ophthalmology coverage is lacking.

Diseases of the Eyelids and Orbit.

The eyelids and orbit encompass intricate bony and soft tissue structures that work harmoniously in concert to protect, support, and nourish the eye in order to facilitate and maintain its function. Insult to periorbital and orbital anatomy can compromise orbital and ocular homeostasis. This article provides a foundational overview of eyelid and orbital anatomy, as well as common and key disorders that may confront internists and medical subspecialists.

Patterns of Facial Fractures in a Major Metropolitan Level 1 Trauma Center: A 10-year Experience.

OBJECTIVE/HYPOTHESIS: To report characteristics and management of facial fractures in a major metropolitan center within the United States. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective review at a level 1 trauma academic medical center of 3,946 facial fractures in 1,914 patients who presented from 2008 to 2017. Demographics, injury mechanism, associated injuries, and treatment information were collected. Logistic regression analyses were performed to determine factors associated with management. RESULTS: There were 1,280 males and 630 females with a median age of 42 years. Orbital fractures were the most common (41.4%) followed by maxilla fractures (21.9%). The most common mechanism was fall (43.6%). Surgical management was recommended for 38% of patients. The odds of surgical management were less for females (OR 0.59, 95% CI 0.48-0.73). Patients over 70 years were significantly less likely to undergo surgery compared to other age groups (OR 0.15-0.36, P < .001). The odds of surgical management were 1.69 times greater for patients with more than three fractures than for a single fracture (95% CI 1.18-2.42) and 2.23 times greater for traffic injuries compared to injuries from activities of daily living (95% CI 1.42-3.5). CONCLUSIONS: This represents one of the largest comprehensive databases of facial fractures. Our patients were most frequently injured during activities of daily living, most commonly from falls. The majority of patients were managed conservatively. Gender, age, fracture number, and mechanism of injury were independently associated with the decision to treat surgically. Our data are in stark contrast to that from other populations in which assault or motor vehicle accidents predominate. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2176-E2180, 2021.

Surgical Treatment and Visual Outcomes of Adult Orbital Roof Fractures.

BACKGROUND: Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis. METHODS: The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses. RESULTS: In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases. CONCLUSIONS: Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Factors Associated With Increased Risk of Serious Ocular Injury in the Setting of Orbital Fracture.

Importance: Orbital fractures are common in ocular trauma, and there is a need to develop predictive tools to estimate risk of concurrent ocular injury. Objective: To identify clinical and radiographic features that are associated with increased risk of substantial ocular injury in the setting of orbital fracture. Design, Setting, and Participants: Retrospective consecutive case series of patients who sustained orbital fractures between 2012 and 2018. Examinations were done at 1 of 2 level 1 trauma centers in the emergency or inpatient setting. A total of 430 consecutive patients (500 eyes) between 2012 and 2017 met inclusion criteria for the training sample. After building a predictive model, 88 additional consecutive patients (97 eyes) between 2017 and 2018 who met inclusion criteria were collected as a test sample. Main Outcomes and Measures: The primary outcome measure was substantial ocular injury distinct from orbital fracture. Results: The mean age of our patient population was 53.5 years (range, 16-100 years). The overall rate of substantial ocular injury was 20.4%, and the rate of injury requiring immediate ophthalmic attention was 14.4%. Five variables were found to be associated with increased risk of substantial ocular injury: blunt trauma with a foreign object (odds ratio [OR], 19.4; 95% CI, 6.3-64.1; P < .001), inability to count fingers (OR, 10.1; 95% CI, 2.8-41.1; P = .002), roof fracture (OR, 9.1; 95% CI, 2.8-30.0; P = .002), diplopia on primary gaze (OR, 6.7; 95% CI, 1.7-25.1; P = .003), and conjunctival hemorrhage or chemosis (OR, 4.2; 95% CI, 2.2-8.5; P < .001). The results were translated into a bedside tool that was tested in an independent group of eyes (n = 97) and found to be associated with substantial ocular injury with a 95% sensitivity (95% CI, 77.2-99.9), 40% specificity (95% CI, 28.9-52.0), 31.8% positive predictive value (95% CI, 27.5-36.5), and 96.8% negative predictive value (95% CI, 81.3-99.5). Conclusions and Relevance: A minority of patients with an orbital fracture had a substantial ocular injury. Certain radiographic and clinical findings were associated with substantial ocular injury. Testing of the algorithm in prospective longitudinal settings appears warranted.

Eyelid and orbital trauma for the primary care physician.

Patients who experience trauma to the eyelid or the orbit may present to their primary care providers or directly to the emergency room for evaluation of their injuries. These patients will often be in pain and may have bleeding around the eye, which can make evaluation of these patients difficult. Many traumatic injuries to the eye require quick and immediate intervention. In this article, we will review the background, anatomy, exam and management of some of the most common eye traumas including eyelid lacerations, orbital hemorrhages, intraorbital foreign bodies, and orbital fractures.

[Reconstruction of Isolated Orbital Floor Fractures by Nasoseptal Cartilage]. / Rekonstrukce izolovaných zlomenin spodiny ocnice nazoseptální chrupavkou.

PURPOSE OF THE STUDY The incidence of isolated orbital floor fractures has an increasing tendency. Their optimal management is not uniform and is still being discussed in the literature. The therapeutic decision as to whether surgical intervention is necessary or conservative approach is adequate vitally depends on clinical and CT findings. Incorrect treatment can lead to serious consequences, especially to persistent diplopia and enophthalmos. The objective of our study was to evaluate the radiological indication criteria for surgery and the clinical outcomes thereafter. MATERIAL AND METHODS The retrospective monocentric study of the group of 53 patients who underwent the isolated orbital floor fracture reconstruction during the period from 1/1/2006 to 31/12/2016 at the Clinic of Otolaryngology and Head and Neck Surgery of the St. Anne's University Hospital, Brno. The ealuated parameters wee the following: trauma cause, clinical symptoms, evaluation of CT parameters (MH index, RF index, MRI index), time interval from injury to surgery, complications. RESULTS Trauma cause: an assault 30/53 (57%), a fall 14/53 (26%), sports 4/53 (7%), a road traffic accident 4/53 (7%), an accident at work 1/53 (2%). Clinical symptoms: eyelid haematoma and/or swelling 53/53 (100%), diplopia 29/53 (55%), emphysema 29/53 (55%), infraorbital nerve hypoesthesia 4/53 (7%). Radiological report of the CT: RF index > 50% (defect length more than a half of the orbital floor length) 49/53 (92%), RF index <50% (defect length less than a half of the orbital floor length) 4/53 (7%). MH index (maximum height of periorbital herniation): mean value 9.0 mm (2.8-14.2 mm), MRI index (rectus inferior muscle index): <1.5 15/53 (28%), ≥ 1.5 38/53 (72%). Time interval from injury to surgery: mean value 11 days (3-21 days). Complications 6 weeks postoperatively: diplopia 4/53 (7%), ectropion 2/53 (4%), enophtalmos 0/53 (0%), visual damage 0/53 (0%). CONCLUSIONS The choice between the surgical and conservative management of the isolated orbital fracture is the key factor to ensure a good therapeutic result. The evaluation of CT findings is crucial for the decision-making process. The key radiological parameters are the standardized assessment of the orbital floor defect size (RF index), orbital tissue herniation (MH index) and the assessment of damage to the intraorbital muscles (MRI index). As demonstrated by the results of our analysis, surgical reconstruction of the orbital floor by nasoseptal cartilage represents a highly effective and safe method. Key words: orbital fractures, blow-out fracture, orbital floor, orbital reconstruction.

The Diagnosis and Management of Facial Bone Fractures.

Appropriate medical care for a patient with a facial fracture can not only optimize aesthetic outcomes but also prevent the potential morbidity and mortality of delayed treatment. In this article, we focus on the clinical presentations, physical examination findings, diagnostic imaging, consultations, and follow-up that patients with facial fractures need related to their emergency department management. Specifically, we address the nuances of evaluating frontal, orbital, nasal, maxillofacial, and mandibular fractures.

Blowout fractures - clinic, imaging and applied anatomy of the orbit.

Isolated fractures of the orbital floor or medial wall are often referred to as blowout fractures (BOFs). Debilitating double vision and aesthetic deformity may affect the patients' quality of life and daily living skills, for instance, working or driving a car. The management of blowout fractures is, however, challenging, since not all fractures demand surgery. Some patients may have symptoms which subside, or may never develop symptoms. Due to a lack of evidence, there are still considerable differences in opinion on the criteria for surgery. The selection of patients for surgery is therefore crucial for optimal patient outcomes. 
The aims of this PhD project were to elucidate and investigate various clinical aspects of blowout fractures and to examine the anatomy of the orbital cavity, which included studying the symmetry of the two orbits, the location of orbital arteries, and the pathophysiology of blowout fractures. Several clinical specialties and basic research fields study the orbital cavity. The studies in this PhD project are based on collaboration between the Departments of Otorhinolaryngology, Ophthalmology and Radiology at the Copenhagen University Hospital Rigshospitalet and the Departments of Odontology and Anatomy (Cellular and Molecular Medicine) at the University of Copenhagen. 
We assessed the current treatment of blowout fractures at the Ear Nose and Throat (ENT) Department at our tertiary hospital in a retrospective study, and found that a third of the patients had persistent double vision 3 months post-trauma, irrespective of whether they had been managed surgically or conservatively (Paper I). We found that the left and right orbit are symmetrical with regards to various morphometrics of both the bony orbit and the intraorbital contents, e.g. volume, surface area and volume of fat and extraocular muscles, and distance to the ethmoidal arteries (Papers II, III and IV). This knowledge may be used in blowout fracture studies on surgical decision-making and orbital reconstruction and also in presurgical planning to avoid iatrogenic damage to the ethmoidal arteries in orbital surgery. In the first longitudinal MRI study of blowout fractures, dynamic post-traumatic changes in the intraorbital soft tissue were detected, i.e. to the best of our knowledge, for the first time indicative of an edema. We conclude that an edema subsides in the days following a blowout fracture and recommend a watchful waiting period before deciding on whether or not to operate (Paper III).
 The 24-12-6 mm rule of thumb determines orbital distances from the anterior lacrimal crest to the ethmoidal arteries and the optic canal. We questioned the applicability of this rule to all patients and investigated whether or not it is feasible to measure the distances on CT images. We found large inter-individual differences in the distances to the ethmoidal arteries and found that preoperative measurements on CT images are feasible and produce results with a low intra- and inter-observer variability.

Retroseptal transconjunctival approach for fractures of the zygomaticomaxillary complex: a retrospective study.

We designed a retrospective study to evaluate the efficacy of retroseptal transconjunctival approaches in the management of fractures of the zygomaticomaxillary complex (ZMC). The patients were from a single institution, and had had three-point fixation of fractures of the ZMC between 2008 and 2016. A total of 77 patients (56 men and 21 women with a mean (range) age of 28 (18-54) years), were divided into two groups. Group I (n=51) had had reduction and fixation of the infraorbital rim using a retroseptal transconjunctival approach. In group II (n=26) the same approach had been used with lateral canthotomy and inferior canthlolysis for both the infraorbital rim and the zygomaticofrontal region. We analysed the association of both approaches with the outcomes of reduction, fixation, and complications. Suboptimal results were found in 13 patients in group I and one in group II (p=0.017). There were also three patients with trichiasis and two with entropion in group I, and one each of both complications in group II. There was only one patient with a malopposed lateral canthus in group II. All 26 patients in group II had no perceptible scar along the extended line of incision. The risk of a suboptimal outcome was reduced by 20% (relative risk=0.8) in group II. The retroseptal transconjunctival approach with lateral canthotomy and inferior cantholysis is safe, aesthetic, and effective in the management of fractures of the ZMC.

Fracturas orbitarias / Orbital fractures

Introducción: las fracturas de la órbita son comunes y difíciles de manejar. Objetivo: realizar una revisión bibliográfica sobre las consideraciones anatómicas, fisiopatología, diagnóstico, tratamiento y complicaciones de las fracturas orbitarias. Métodos: se realizó una revisión bibliográfica en septiembre de 2016. Se evaluaron revistas de impacto de Web of Sciencies (35 revistas). Se consultaron las bases de datos MEDLINE, PubMed y SciELO con los descriptores: orbital fracture, treatment, epidemiology. Se incluyeron artículos en idioma inglés y español de los últimos 5 años. Se obtuvieron 127 artículos. El estudio se circunscribió a 47. Análisis e integración de la información: la órbita presenta debilidad anatómica en el piso y la pared medial que provoca una mayor afectación por fracturas. Existen varias teorías que justifican su aparición. El diagnóstico se basa en los hallazgos clínicos, incluidos los oftalmológicos, y medios auxiliares de diagnóstico; lo cual permite escoger la modalidad terapéutica y evitar complicaciones. Conclusiones: basados en el dominio de la anatomía y los métodos diagnósticos, la gestión de estas lesiones ha cambiado poco en los últimos años. Sin embargo, los avances en las imágenes orbitales, la introducción de sistemas de navegación intraoperatoria, mejores indicaciones quirúrgicas y diseños de implantes han llevado a una reevaluación del enfoque terapéutico de las fracturas orbitarias(AU)

Introduction: fractures of the orbit are common and difficult to manage. Objective: to carry out a bibliographic review on anatomical considerations, physiopathology, diagnosis, treatment and complications of orbital fractures. Methods: abibliographic review was carried out in September 2016. Journals of impact in the Web of Sciences (35 journals) were evaluated. The databases MedLine, PubMed and ScieELO were consulted with the descriptors: orbital fracture, treatment, and epidemiology. Articles in English and Spanish language of the last 5 years were included. 127 articles were obtained. The study was circumscribed to 47. Analysis and integration of information: the orbit presents anatomical weakness in the floor and the medial wall, which causes greater affectation due to fractures. There are several theories that justify its onset. The diagnosis is based on clinical findings, including ophthalmological findings, and diagnostic aids, which allows choosing the therapeutic modality and avoiding complications. Conclusions: based on the mastery of anatomic and diagnostic methods, the management of these lesions has changed little in recent years. However, advances in orbital imaging, the introduction of intraoperative navigation systems, better surgical indications and implant designs have led to a reassessment of the therapeutic approach to orbital fractures(AU)

Orbital Floor Fractures.

The orbital bones are thin and exposed, making the orbital walls vulnerable to fractures. The floor of the orbit is the weakest portion of this 4-sided pyramid structure. Blunt force trauma is the primary mechanism of injury in young men between the ages of 18 and 30 years. Computerized tomography is the primary imaging technique to diagnose orbital fractures. Conservative versus surgical management is determined by maxillofacial and ophthalmology specialists.

Indications for repositioning of blow-out fractures of the orbital floor based on new objective criteria - tissue protrusion volumometry.

BACKGROUND AND AIM: The otolaryngologist often meets with fractures of the orbital floor. The most serious complication is diplopia, arising as a result of herniation of the orbital contents, with or without fixation of the inferior rectus muscle. The aim of our work was to create a mathematical model to calculate the volume of prolapsed soft tissue of the orbit in blow-out fractures, as a factor in deciding on the need for surgical treatment. PATIENTS AND METHODS: In a retrospective study (2007-2013), we evaluated 80 patients with blow-out fractures, divided into two equal groups: 40 conservatively treated and 40 surgically treated patients. We created the model by measuring the fracture lines and herniation of the orbital soft tissues in the coronal and sagittal sections from CT images, equivalent to half the volume of a rotating ellipsoid. RESULTS: According to the proposed model, posterior and anterior fractures with a prolapse volume above 500 mm3, and anteroposterior fractures with a volume over 1400 mm3, are indicated for surgery. CONCLUSION: The volume of prolapsed soft tissue relative to the location of the fracture is the main indicator for selecting the best treatment procedure immediately after injury.

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.

Maxillofacial and Mandibular Fractures in Sports.

Sports account for 3% to 29% of facial injuries and 10% to 42% of facial fractures. Fractures of the facial skeleton most commonly occur owing to interpersonal violence or motor vehicle crashes. Facial fractures from sporting activities has clearly decreased over time owing to better preventive measures. However, this decreasing trend is offset by the emergence of more dangerous sports activities, or "pushing the envelope" of traditional sports activities. Fractures can occur from contact between athletes, and between athletes and their surroundings. Football, soccer, hockey, and baseball most frequently are involved in sports-related cases of facial bone fracture.

[Bone cement implant as an alternative for orbital floor reconstruction: A case report]. / Implante de cemento óseo como alternativa para la reconstrucción de piso orbitario: reporte de caso.

BACKGROUND: The management of orbitary fractures is one of the most challenging in facial trauma; the variety of reconstruction materials for its treatment is broad and is constantly improving, but despite this there is no consensus for its use or literature that sustains it. OBJECTIVE: To present the use and design of a preformed bone implant as an alternative for the reconstruction of orbital floor fractures in the pediatric age group. CLINICAL CASE: A 7-year old male who suffered a right hemifacial contusion trauma with clinical and tomographic diagnosis of right pure blowout type orbital floor fracture with inferior rectus muscle entrapment and right post-traumatic palpebral ptosis. Successful surgical reconstruction was performed 7 days later with a pre-constructed bone cement implant. Eight weeks after surgery the patient presented with mild residual palpebral ptosis, no ocular movement limitations and no diplopia. CONCLUSIONS: The use of a bone cement implant can be considered appropriate for the reconstruction of these fractures, as another alternative to be used by the ophthalmologist among the variety of all the other materials used for this purpose. We consider that our optimism based on the results obtained in this case obligates us to increase the number of patients treated in order to gather more evidence and do larger follow up.

Tratamento de fratura de assoalho orbital com cartilagem conchal / Treatment of orbital floor fracture with conchal cartilage

Introdução: A reconstrução dos defeitos no assoalho orbital após fraturas constitui um desafio ao cirurgião plástico, pois além da expectativa estética e reconstrutora do paciente, cabe o tratamento de possíveis complicações funcionais, como diplopia e parestesias faciais. O objetivo é demonstrar uma série de casos utilizando cartilagem auricular conchal para reposição volumétrica orbital e estrutural do assoalho. Métodos: Foram avaliados 24 pacientes, operados pelo autor deste trabalho no período de 2013 a 2016, por motivo de fraturas de assoalho orbital pura (blow-out) ou impura (conjugadas a lesões de margem orbital, como zigoma e maxila). A técnica de estruturação do assoalho utilizou enxerto cartilaginoso autólogo conchal em todos os casos. Os pacientes foram catalogados quanto à presença de queixas pré-operatórias, como parestesia e diplopia, e sintomas, como enoftalmia, assim como resultados pós-operatórios. Resultados: A presença de lesões concomitantes como fratura de complexo zigomático e fratura maxilar pode influenciar no sucesso da reconstrução, assim como as fraturas com maior área de descontinuidade no assoalho orbital. Poucos pacientes apresentaram queixas pós-operatórias e somente dois casos (9,2%) necessitaram de nova abordagem cirúrgica. Conclusão: A cartilagem conchal auricular autóloga é um material adequado à reconstrução de defeitos no assoalho orbital pós-fratura, apresentando como vantagens a fácil obtenção, baixa morbidade, cicatriz inconspícua, excelente adaptação ao formato do assoalho da órbita e consequente reposição volumétrica.

Introduction: The reconstruction of defects in the orbital floor after fractures poses a challenge to the plastic surgeon because besides the patient's aesthetic and reconstructive expectations, possible functional complications such as diplopia and facial paresthesia must be treated. This study aimed at reporting a series of cases in which conchal auricular cartilage was used for volumetric orbital and structural replacement of the floor. Methods: Twenty-four patients, with surgery performed by the author, between 2013 and 2016, for pure (blow-out) or impure (conjugated to orbital margin injuries, such as zygoma and maxilla) orbital floor fractures, were evaluated. The repair technique involved autologous conchal cartilage graft in all cases. Patients were classified for the presence of preoperative complaints, including paresthesia and diplopia, and symptoms such as enophthalmia, as well as postoperative outcomes. Results: The existence of concomitant lesions, such as zygomatic complex and maxillary fracture, as well as fractures with greater discontinuity in the orbital floor, may influence the success of reconstruction. Few patients exhibited postoperative complaints and only two (9.2%) required a new surgical approach. Conclusion: Autologous conchal auricular cartilage is a suitable material for reconstruction of defects in the post-fracture orbital floor, possessing various advantages, including ease of attainment, low morbidity, inconspicuous scar, and excellent adaptation to the shape of the orbital floor and consequent volumetric replacement.

The Role of Resorbable Plate and Artificial Bone Substitute in Reconstruction of Large Orbital Floor Defect.

It is essential to reduce and reconstruct bony defects adequately in large orbital floor fracture and defect. Among many reconstructive methods, alloplastic materials have attracted attention because of their safety and ease of use. We have used resorbable plates combined with artificial bone substitutes in large orbital floor defect reconstructions and have evaluated their long-term reliability compared with porous polyethylene plate. A total of 147 patients with traumatic orbital floor fracture were included in the study. Surgical results were evaluated by clinical evaluations, exophthalmometry, and computed tomography at least 12 months postoperatively. Both orbital floor height discrepancy and orbital volume change were calculated and compared with preoperative CT findings. The average volume discrepancy and vertical height discrepancies were not different between two groups. Also, exophthalmometric measurements were not significantly different between the two groups. No significant postoperative complication including permanent diplopia, proptosis, and enophthalmos was noted. Use of a resorbable plate with an artificial bone substitute to repair orbital floor defects larger than 2.5 cm(2) in size yielded long-lasting, effective reconstruction without significant complications. We therefore propose our approach as an effective alternative method for large orbital floor reconstructions.

Management of complex orbital fractures.

The treatment of orbital injuries has evolved considerably over the last two decades. We describe strategies involved in the emergency management of orbital injuries, the use of imaging, preformed and customised materials for reconstruction, and endoscopic techniques.