I am concerned that my eye is displaced after an orbital floor fracture. I had surgery 5+ weeks ago to repair the orbital floor and zygoma. It appears that the injured eye is lower and more posterior than the other. What are my options? If it ends up that my eye is out of position, what is the procedure to correct it? When will I be able to undergo such a procedure, given I just had surgery on the area less than 2 months ago? My left lower eyelid sags from the transconjunctival incision btw.
Enophthalmos And/or Hypoglobus After Orbital Floor Fracture? (photo)
Doctor Answers 6
Thank you for the question. Based on the photo provided your eye or globe appears to be in the corect position. However, the lower eyelid appears "pulled down" this is called ectropion or scarring of the lower eyelid. Often the lower eyelid will not be able to fully close from the scarring. This can cause a dry and imflamed eye. You should return to your surgeon as soon as possible. They will most likely give you eyedrops and have you massage the eyelid. Ectropion will often require a secondary surgery to correct the scarring.
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Enophthalmos and Lower Eyelid Malposition
The correction in these cases is never perfect. In the absence of double vision, you should wait for several months for resolution of swelling. The lid should be massaged and nighttime taping instituted as conservative measures for eyelid malposition.
Orbital Floor Fracture
I agree with previous posters that there is evidence of ectropion which will likely require surgical correction. Although it is best to wait and allow inflammation to subside, earlier intervention is sometimes necessary because of dry eye symptoms. Unfortunately, even in best case scenarios with an orbital blow out fracture, some degree of orbital volume loss and enophthalmos can occur. This can be countered with placement of an orbital floor implant. However, it would be optimal to wait 6 months to a year prior to proceeding. Additionally, this type of procedure is probably best performed by an ASOPRS trained Occuloplastic Surgeon.
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Lower Eyelid Ectropion Problem After Cheekbone Fracture Repair
I think you have an isolated lower lid retraction but not a globe displacement issue. Even though it is only 5 weeks after surgery, I think you are going to require an ectropion repair. It is not a question of if but when. If there is no substantial improvement by three months after surgery, then a lid repositioning procedure is justified given the severity of your problem.
Enophthalmos after orbital fracture repair
I would wait a total of 6 months and consider an orbital floor implant to increase the orbital volume and push the globe up. They come in different thicknesses.
You May Also Consider Fillers
I agree with the other post. You do have ectropion and enopthalmos. Depending on the severity of the two issues, you may require surgery and you might want to consider fillers to the cheek area. Fillers in this area can improve the symmetry of your face and push up your lower lid.
I hope this helps.
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