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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11419
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

Customer Question

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: 4 years ago.
Category: Eye
Expert:  Dr. Rick replied 4 years 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 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 ;)
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Thanks in advance,
Dr. Rick MD FACS