J Korean Ophthalmol Soc.  2019 Jun;60(6):501-509. 10.3341/jkos.2019.60.6.501.

Using Computed Tomography: Predictive Factors for Recovery Time in Patients with Orbital Fracture with Diplopia

• Ahn JH
• Park SJ
• Chi MJ

• KMID: 2449702
• DOI: http://doi.org/10.3341/jkos.2019.60.6.501

Abstract

PURPOSE
To identify predictive factors for recovery time in patients with orbital fracture with diplopia through analysis of preoperative and postoperative computed tomography (CT) images and postoperative recovery time.
METHODS
We retrospectively analyzed CT findings-preoperative: fracture size, type of fracture, fracture site, extraocular muscle (EOM) swelling, EOM and soft tissue injury, and the amount of soft tissue herniation; post-operative: degree of enophthalmos, and diplopia recovery period in 379 patients who underwent surgical treatment for orbital fracture between March 2006 and December 2015.
RESULTS
The average postoperative follow-up period was 556.2 ± 59.5 days, and the mean duration of recovery was 23.9 ± 42.5 (range, 3-186) days. The recovery time of diplopia was significantly increased with the following preoperative CT findings: fracture size (small and medium < large) (p = 0.049), type of fracture (linear < hinge < comminuted, trap-door) (p < 0.01), fracture site (inferior < medial and both) (p < 0.01), EOM and soft tissue injury (prolapse and torsion, muscle entrapment, kinked muscle) (p < 0.01), and the amount of soft tissue herniation (small and medium < large) (p < 0.001). The mechanism of injury, sex, age, and the degree of enophthalmos were not related to the length of the diplopia recovery period.
CONCLUSIONS
The length of diplopia recovery could be predicted by CT findings.

Keyword

Computed tomography; Diplopia; Orbital fracture

MeSH Terms

Diplopia*
Enophthalmos
Follow-Up Studies
Humans
Orbit*
Orbital Fractures*
Retrospective Studies
Soft Tissue Injuries

Figure

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  Figure 1 The size and type of blowout fracture. The size of the orbital wall fracture classified into small (< 20%) (A), medium (B) and large (> 50%) (C). The type of the orbital wall fracture classified into linear (D), hinged (E), comminuted (F) and trapdoor (G).

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  Figure 2 Extraocular muscle swelling. The measurement of extraocular muscles (white arrow, short axis; black arrow, long axis).

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  Figure 3 Soft tissue herniation. Amount of soft tissue herniation classified into small (only soft tissue, small amount) (A), medium (only soft tissue, large amount) (B) and large (soft tissue with muscle, large amount) (C).

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  Figure 4 Extraocular muscle and soft tissue injury. Extraocular muscle and soft tissue injury type classified into muscle prolapse without torsion (A), muscle torsion without prolapse (B), muscle prolapse with torsion (C), kinked muscle by bone (D), muscle entrapment (E) and soft tissue entrapment (F).

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  Figure 5 Enophthalmos. Degree of enophthalmos (6 to 12 months after the surgery).

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