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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
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Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I blew out my orbital floor (left eye) playing sports 9 days

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I blew out my orbital floor (left eye) playing sports 9 days ago. CT scan findings are:

[A large fracture deformity of the orbital floor. The fracture deformity is medial to the roof of the infraorbital nerve. There is inferior herniation of extraconal fat through the defect. The inferior rectus muscle is also partially herniated into the defect. There is a small amount of retrobulbar gas which does not appear to have significant mass effect on the ocular globe or the optic nerve insertion on the globe. There is no retrobulbar hematoma. There is no apparent contour deformity of the ocular globes.] I have a bit of diplopia when looking extremely down or up, with looking down being more severe that it affects my reading abilities. The oculopastic surgeon I met could not definitively determine from CT scan if there was muscle entrapment but suspicions it due to the continued diplopia. My doctor also says that if there is muscle entrapment and it is corrected with surgery, the diplopia can initially get worse. (And if it doesn't improve, follow on operations to repair the muscle may be required.)

Is surgery the optimal course to take? In addition, is this a fairly frequent ailment that oculopastic surgeons deal with and are thus very skilled in? How long does it take for recovery (from a cosmetic point of view of the face)? How long does full recovery typically take? Will I eventually look and be able to function as normally as I used to prior to my injury? Please help. Thank you.
Submitted: 11 months ago.
Category: Eye
Expert:  Dr. Rick replied 11 months ago.
Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Let me answer your questions in order:

1. With your continued diplopia and CT suspicion of IR muscle entrapment, it does seem like surgical repair is the way to go.

2. This is what oculoplastic surgeons were invented for. They will do an excellent job :)

3. That is different from patient to patient. I would not let cosmetic issues hold you back from surgery.....you do not want double vision for the rest of your life.

4. Full recovery, once again, varies from person to person, but you should be back to normal in about 6 weeks and be able to return to your regular activities and job after 24 to 48 hours post-op.

5. Let me check my crystal ball. Darn. It's broken...again. :)

So. All kidding aside, if your IR is entrapped you may have problems for the rest of your life without surgical repair. As such, although on doctor can tell you if you will eventually look and be able to function as normally as you used to, in my opinion, from what you have posted, surgical repair seems like the correct choice.

Whew! That was a lot of typing...I'm gonna have to go rest my fingers for a bit now ;)

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

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