Prevalence of Diplopia and Extraocular Movement Limitation according to the Location of Isolated Pure Blowout Fractures

Background Isolated pure blowout fractures are clinically important because they are the main cause of serious complications such as diplopia and limitation of extraocular movement. Many reports have described the incidence of blowout fractures associated with diplopia and limitation of extraocular movement; however, no studies have statistically analyzed this relationship. The purpose of this study was to demonstrate the correlation between the location of isolated pure blowout fractures and orbital symptoms such as diplopia and limitation of extraocular movement.

Methods We enrolled a total of 354 patients who had been diagnosed with isolated pure blowout fractures, based on computed tomography, from June 2008 to November 2011. Medical records were reviewed, and the prevalence of extraocular movement limitations and diplopia were determined.

Results There were 14 patients with extraocular movement limitation and 58 patients complained of diplopia. Extraocular movement limitation was associated with the following findings, in decreasing order of frequency: floor fracture (7.1%), extended fracture (3.6%), and medial wall (1.7%). However, there was no significant difference among the types of fractures (P=0.60). Diplopia was more commonly associated with floor fractures (21.4%) and extended type fractures (23.6%) than medial wall fractures (10.4%). The difference was statistically significant (Bonferroni-corrected chi-squared test P<0.016).

Conclusions Data indicate that extended type fractures and orbital floor fractures tend to cause diplopia more commonly than medial wall fractures. However, extraocular movement limitation was not found to be dependent on the location of the orbital wall fracture.

Keywords

Orbital fractures - Eye movements - Diplopia - Chi-squared distribution

This article was presented at the 68th Congress of the Korean Society of Plastic and Reconstructive Surgeons on November 4-7, 2010 in Seoul, Korea.

Publication History

Received: 31 January 2012

Accepted: 09 March 2012

Article published online:
01 May 2022

• REFERENCES

• 1 Burm JS, Chung CH, Oh SJ. Pure orbital blowout fracture: new concepts and importance of medial orbital blowout fracture. Plast Reconstr Surg 1999; 103: 1839-1849
• 2 Converse JM, Smith B, Obear MF. et al. Orbital blowout fractures: a ten-year survey. Plast Reconstr Surg 1967; 39: 20-36
• 3 Biesman BS, Hornblass A, Lisman R. et al. Diplopia after surgical repair of orbital floor fractures. Ophthal Plast Reconstr Surg 1996; 12: 9-16
• 4 Han JS, Koo SH, Han SK. et al. Blow-out Fracture: clinical study of surgically treated 54 cases. J Korean Soc Plast Reconstr Surg 1995; 22: 1138-1146
• 5 Lee JH, Ryu MH, Kim YH. Classification of blowout fracture. J Korean Soc Plast Reconstr Surg 2007; 34: 719-723
• 6 Eun SC, Heo CY, Baek RM. et al. Survey and review of blowout fractures. J Korean Soc Plast Reconstr Surg 2007; 34: 599-604
• 7 Waterhouse N, Lyne J, Urdang M. et al. An investigation into the mechanism of orbital blowout fractures. Br J Plast Surg 1999; 52: 607-612
• 8 Ahmad F, Kirkpatrick NA, Lyne J. et al. Buckling and hydraulic mechanisms in orbital blowout fractures: fact or fiction?. J Craniofac Surg 2006; 17: 438-441
• 9 Cramer LM, Tooze FM, Lerman S. Blowout fractures of the orbit. Br J Plast Surg 1965; 18: 171-179
• 10 Higashino T, Hirabayashi S, Eguchi T. et al. Straightforward factors for predicting the prognosis of blow-out fractures. J Craniofac Surg 2011; 22: 1210-1214
• 11 Tahiri Y, Lee J, Tahiri M. et al. Preoperative diplopia: the most important prognostic factor for diplopia after surgical repair of pure orbital blowout fracture. J Craniofac Surg 2010; 21: 1038-1041
• 12 Putterman AM. Management of orbital floor blowout fractures. Adv Ophthalmic Plast Reconstr Surg 1987; 6: 281-285
• 13 Manson PN, Clifford CM, Su CT. et al. Mechanisms of global support and posttraumatic enophthalmos: I. The anatomy of the ligament sling and its relation to intramuscular cone orbital fat. Plast Reconstr Surg 1986; 77: 193-202
• 14 Whyte DK. Blowout fractures of the orbit. Br J Ophthalmol 1968; 52: 721-728
• 15 Mathes SJ, Hentz VR. Plastic surgery. 2006. 2nd ed. Philadelphia: Saunders Elsevier;
• 16 Hwang WB, Bae YC, Jeon JY. et al. Orbital volume change in post-traumatic enophthalmos. J Korean Soc Plast Reconstr Surg 1997; 24: 1031-1043
• 17 Huh SH, Yang WY, Hong SP. et al. A study on the clinical improvement according to the fracture sites pure blow-out fracture. J Korean Soc Plast Reconstr Surg 1998; 25: 1060-1066