Reconstruction of orbital floor blow-out fractures with silicone implant.

AIM: To evaluate the outcome of orbital floor blow-out fractures treated surgically with silicone implant. METHODS: The patients were examined in a prospective study from October 1993 to December 1999. Over this period 11 patients were diagnosed as having orbital floor blow-out fractures. The study was restricted to those who were both treated surgically and followed-up at least three months after the discharge from hospital. Only six patients (five males and one female), ranging in age from 6 to 30 years, fulfilled the inclusion criteria. The fractures occurred during brawls in 3 patients, car accidents in 2 patients and child's play in 1 patient. The diagnosis was based on history, clinical grounds and coronal computed tomography. The surgical procedure was the same in all patients, using silicone implant to reconstruct the defects. The mean follow-up time after surgery was 4.8 months. RESULTS: The interval between injury and diagnosis ranged from 6 to 85 days (mean: 34.8 days). Limitation of vertical eye movements was present in all 6 patients, diplopia in 4 patients, enophthalmos in 3 patients and hypoesthesia in the distribution of the infraorbital nerve in 1 patient. The mean interval time between injury and surgery was 55.3 days and the majority of the patients (83%) had late repairs (> 14 days) after injury. Postoperatively, satisfactory results were obtained with regard to limitation of vertical eye movements, diplopia, enophthalmos and hypoesthesia. Only one patient had a persistent and partially reduced enophthalmos. Silicone implant was well tolerated in all 6 cases since complications such as infection, tissue reaction and extrusion were not observed. CONCLUSION: Satisfactory results may be obtained after late repair of orbital floor blow-out fractures. Silicone implant has the potential to be used successfully in orbital floor fractures.

[Solar retinopathy acquired after gazing at the sun during prayers]. / Rétinopathie solaire acquise durant des séances de prière.

The authors present the results of a study based on six persons who developed retinopathy after gazing at the sun during prayers. Risk factors were studied and the prognosis evaluated. The mean follow-up time was 82 days. Risk factors were present in all patients. The visual acuity was reduced in all patients at first presentation and total improvement was noted in four of them. Of all six patients, only one had his ocular fundus normalized. Amsler's grid testing revealed in all patients bilateral central scotomas which persisted in four of them. Fluorescein retinal angiography, which was found to be abnormal in all cases, became normal in only one case. However, all patients continued to complain of visual disability because of the persistence of photophobia, meta-morphopsia and scotomas. In conclusion, the prognosis of solar retinopathy is variable and the recovery of visual acuity does not necessarily imply the improvement of vision. Appropriate eye protection such as solar filters must be used when gazing at the sun to protect from retinal damage.