Timing for Orbital Fracture Repair and its Effects on Extraocular Muscle Function

Tomoyuki Kashima

Purpose:
To study the impairment of extraocular muscle (EOM) function in patients with orbital fractures and changes in ocular motility followed surgical repair performed at different time intervals followed injury

Methods:
Retrospective case review on 155 patients with open orbital wall fracture and underwent surgical repair in our institute from April 2006 to June 2008. Patients' demographics, time interval between injury and surgery, EOM motility pre-operation and 3 months post surgery were evaluated using Hess Chart Area Ratio (HAR) defined by Furuta. 1

Results:
We reviewed the improvement in HAR pre and post operation according to age groups and time intervals between injury and surgical repair. The mean age of patients was 32.9 years. The male to female ratio was 110:45. Mean interval between injuries to surgery was 91.2 days. The HAR changes for age group < 20yrs ( 31patients ) were 77.5 to 95.8, 21-40yrs ( 83patients ) 71.4 to 92.1, 41-60yrs (30patients) 55.9 to 83.3 and >60yrs (11patients) 42.3 to 74.2. The differences in HAR values were significantly different for patients < 20 years and > 40 years (p<0.007 and <0.006). The HAR changes for those operated within 2 weeks (106patients) was 69-93, between 2-4 weeks ( 22patients) 68-91, more than 4 weeks (27patients) 70- 85. Statistically significant improvement (p=0.027) was observed between patients operated within 2 weeks and> 4 weeks.

Conclusions:
Patients who were younger or had orbital fracture repair surgically within 2 weeks after injury had significantly better recovery of EOM function as measured by HAR.

References :
Ref 1 : Furuta M, Yago K, Iida T. " Correlation between ocular motility and evaluation of computed tomography in orbital blowout fracture." Am J Ophthalmol. 2006 Dec;142(6):1019-25.