No Improvement After Orbital Floor Reconstructive Surgery? (photo)

Hi, I had a blowout fracture 1986 when i was 12 that was repaired.Fast forward to 2011 and i hated what i saw in pictures,A very droopy eye that had gotten worse over the years so i saw a maxofacial/ocular surgeon and had surgery in Oct 2011.He put some kind of bone type plate in there to "build up the floor" secured with screws and said it would be fixed now.Well it is exactly the same as before and it has been 16 weeks since surgery.I go for my final follow up next week.What are my options?

Doctor Answers 4

Delayed orbital blowout repair is never easy

Hi Chip,

These delayed repairs are extraordinarily difficult.  Unfortunately the photo you supplied is not clear enough to really see what is going on, but my suggestion is that you see a specialist who specifically has had experience with complex bony orbital reconstruction. In my experience, multiple surgeries is the rule, not the exception, with these delayed repairs.  Good luck.  Minas Constantinides, MD

Austin Facial Plastic Surgeon
3.9 out of 5 stars 7 reviews

Revision orbital surgery

Secondary and tertiary orbital surgery can be tricky.  Your photo shows some asymmetry between your orbits - I would need to see 3D reconstructions of your CT scan to help plan a definitive correction.  Doing this surgery digitally first and being able to plan things on the computer using CAD/CAM makes the results worlds better and more accurate.

With childhood trauma, the growth of that orbit was likely affected, and just building up the floor is not going to give an adequate correction.

See a board-certified plastic surgeon with craniofacial training for a second opinion.

Hope this helps,

Dr. Hall

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 11 reviews

Orbital fracture revision

In looking at your photo, it appears the right eyelids are drooping somewhat and the corners of the eyes are uneven.  An orbital surgeon should be sought to evaluate the positions of these tissues and assess if they can be repositioned.  These surgeries can be difficult, but you should be able to achieve better symmetry.

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

CT scan is imperative


From the photo, two things are apparent:

1. The left eye is lower than your right eye

More importantly:

2. Your medial canthus/lateral canthus position is also low. The canthi [plural for canthus] are the anatomic landmark of the upper and lower eyelids coming together: the so called "corner of my eye". The medial canthus is the one adjacent to the nose and the lateral canthus is the outside corner.  Both these anatomic landmarks are also lower on the right than the left side.

This may be an underlying anatomic asymmetry that you have had your whole life and are now realizing because attention has been drawn to it by the injury. You can look for this in old photos. Make sure you pick ones in which you are NOT tilting your head. Often times, a "new" finding is the realization of an old finding.

Of course, it is also possible that this is the result of the trauma. If that is the case, your fracture wasn't a pure "blowout fracture".  A blowout fracture refers to the bone INSIDE the eye socket. This doesn't change the position of the canthi. Fractures to the external bones of the eye socket [ so called Tripod or NOE, naso-orbito-ethmoid fractures]  can change the canthal position.

You need a current CT scan [maxillofacial thin cuts] and old photographs to figure out this anatomy. An experienced trauma surgeon [Oculoplastics, facial Plastics, Craniofacial, or Maxillofacial] consultation is necessary.

Best of Luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

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