My father has an orbital blowout on his right floor orbit. He is an elderly man with limited vision due to restricted blood to his cornea. The injury occurred under a week ago. A surgeon recommended that we have surgery done asap. The only thing is that we are hesitant to do so due to his age. He also does not have double vision and both eyes look to be level. The surgeon said that it is a preventative measure to avoid possible diplopia and enophthalmos. Should we do surgery or will the eye heal
Orbital blowout question in regards to having surgery done or letting the eye heal itself?
Doctor Answers 3
Indications for orbital fracture surgery
Not all orbital fractures (eye socket, "blow-out") need to be repaired. There are certain indications: 1) diplopia (double vision); 2) enophthalmos (sunken eye); 3) large fracture which can lead to enophthalmos. See an oculoplastic surgeon for evaluation. (Your father probably doesn't need surgery if he doesn't have any of these criteria.)
Orbital blowout fracture and urgent surgery
first things first. Many orbital blowout fractures are not emergencies.unless there is bleeding in the orbit with compromise of vision or entrapment of muscles that move the eye inside the fracture line it is not an absolute emergency. Yes this surgery can help the position of the eye and yes in some cases it can prevent diplopia and enophthalmos in the future.
However, let me caution U if he has poor blood flow to his cornea due to his age or other eye related disease you on a strongly consider possibility that he could lose vision altogether. This is very unlikely but diplopia and enophthalmos are not emergencies by themselves. Get an evaluation with at least 1 ophthalmologist and 1 oculoplastic surgeon before proceeding. Outside of this the surgeon most qualified to perform the surgery as a facial plastic surgeon or oculoplastic surgeon who performs this particular surgery frequently.
Go see your ophthalmologist
Chase Lay, MD
Double board-certified facial plastic surgeon
This can be determined by CT scan.
Persistent double vision and enopthalmos are not emergencies. Not occasionally surgeons will imply that these conditions warrant urgent surgery which may have more to do with the surgeons fee than the patient's medical needs. True emergencies to occur in the setting of orbital fractures which include orbital hemmorhage, the so-called white eye blow out in young people where extra ocular muscle gets entrapped in the fracture and becomes ischemic, and another unusual situation where the heart rate slows because of entrapped orbital tissue, again more common in young people. If your father is not experiencing any of these urgent situations, there is time for other opinions. If he does not have double vision now, he is more likely to develop it as a complication of repair. This would make enophthalmos the most likely long term consequence. An experienced orbital surgeon can help him weight the relative risk of orbital fracture repair versus enophthamos. Small degrees of enophthalmos are hard to notice and an older individual in poor health may choose to tolerate a larger amount of enopthalmos as an alternative to orbit surgery. I recommend having him evaluated by the Ophthalmic Plastic and Orbital Surgery Services at the Jules Stein Eye Institute at UCLA. If finances are an issue, he can be assesses in the Opthalmology Department at the Los Angeles County/Harbor UCLA Medical Center in Torrance.
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